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APPROVAL OF THE DOSIMETRIC INSTITUTE OF MEDICINE OF PARIS, 1886 
FIRST (BURGGRAEVE) PRIZE, AMOUNT 2,000 FRANCS 



ELEMENTS OF THERAPEUTICS 
AND PRACTICE 



ACCORDING TO THE 



DOSIMETRIC SYSTEM 



J BY / 

DR. D'OLIVEIRA CASTRO 




NEW YORK 

D. APPLETON AND COMPANY 

1888 



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Copyright, 1888, 
By D. APPLETON AND COMPANY. 



THE AUTHOR DEDICATES THIS WORK 

TO THE ILLUSTRIOUS 

DR. BURGGRAEVE, 

AUTHOR OF THE DOSIMETRIC SYSTEM OF MEDICINE, 

Officer of the Order of Leopold of Belgium and of the 

Order of Christ of Portugal, 

Commander of the Order of Charles III of Spain, 

Professor Emeritus of the University and 

Principal Honorary Surgeon of the Civil Hospital of Gand ; 

Titulary Member of the Academy of Medicine of Belgium, 

Honorary Member of the Society of Russian Physicians of St. Petersburg ; 

Corresponding Member of the Society of Surgery of Moscow, 

of the National Society of Surgery of Paris, of the 

Royal Academy of Medicine of Madrid ; 

Foreign Associate Member of the Academy of Sciences of Lisbon, 

Corresponding Member of the Society of the Medical Sciences of Lisbon, 

Corresponding Member of the Imperial Academy of Rio de Janeiro, 

Original Member of the Society of Medicine of Gand, 

Corresponding Member of different Medical Societies of Belgium, etc. 

Civic Cross for fifty years of public services. 






TO 

M. CHARLES CHANTEAUD, 

Chevalier of Charles III, Commander of Isabella the Catholic, 

Commander of the Order of Christ of Portugal, 

Pharmacist of the First Class in Paris, 

Sole Preparer of Dosimetric Medicaments. 



PREFACE TO THE AMERICAN EDITION. 



Tins translation has been made for several laymen 
of New York and Boston who, having derived great 
benefit themselves from the daily nse of the alkaloids 
as recommended by Dr. Burggraeve, are desirous of 
bringing this admirable book to the knowledge of the 
physicians of the United States. 

The new method of treatment of disease described 
in this book is called Dosimetry — that is, the medicine 
of small doses mathematically measured. The gran- 
ules contain accurately weighed quantities of simple 
substances whose chemical composition is invariable, 
whose effects are always the same, and are such that 
they can be calculated with great certainty in advance. 

These substances are the active principles of the 
plants, and are, for the most part, crystallized alka- 
loids. 

Dr. Burggraeve, an eminent professor of the Univer- 
sity of Ghent, is the author of this new method of 
medical treatment. He was the chief surgeon of the 
Hospital of Ghent, and many years ago was deeply 
impressed by the great mortality among those who 
had been operated upon. He found that about two 
thirds of them died in consequence either of trauma- 
tism or of purulent infection. Later the antiseptic 
dressings of Lister reduced the mortality to fifteen and 



vi PREFACE TO THE AMERICAN EDITION. 

twenty per cent. Subsequently Dr. Burggraeve, by his 
alkaloido-therapeutic treatment, both preventive and 
curative, brought the mortality down to two and a half 
and 1iYe per cent, where it has since been maintained. 

He judged that the traumatic fever was due to a 
stoppage of blood in the capillaries, caused by a pa- 
ralysis or a fatigue of the vaso-motor nerves which 
control the circulation. 

He thought that, by restoring to these nerves their 
tone and improving their vitality, he would bring 
back the circulation to its normal condition and put a 
stop to that stagnation of the blood which is at first a 
source of heat and then of inflammation, and thus be- 
comes the origin of congestion, changes of texture, 
and finally of lesions. 

He recalled to mind a successful treatment of inter- 
mittent fever and cholera in Russia, in 1832, by Dr. 
Mandt, of St. Petersburg, described in a memoir upon 
Indian cholera, which was read in 1854 by Dr. Everard 
before the Royal Academy of Medicine of Belgium. 

The Academicians paid no attention to this memoir, 
they did not even discuss it, the cholera epidemic hav- 
ing ceased. Dr. Burggraeve, however, found in this 
memoir material for serious study, and he decided to 
apply Dr. Mandt's methods to the fever cases which 
came under his charge in the Hospital of Ghent. He, 
however, substituted alkaloids for the substances of 
the plants which Mandt had used. He gave to his 
patients strychnine in small doses, repeated at short 
intervals, to give tone to the vaso-motor nerves, and 
thus to re-establish the circulation of the blood. At 
the same time with the strychnine he gave small doses 
of aconitine and veratrine, to lower the temperature 



PREFACE TO THE AMERICAN- EDITION. vii 

and stop the fever. He thus made the discovery that 
it is sometimes possible to prevent the fever, very often 
to jugulate it, and always to check the fever syndrome. 

Encouraged by this success, he studied upon him- 
self and others the effects of the different alkaloids 
which he thought suitable to introduce into therapeu- 
tics. 

In his " Manuel di Pharmacodynamic " he describes, 
in a summary manner, the physiological and thera- 
peutic action of the principal agents employed in 
dosimetry. He also established some simple rules of 
treatment, simple in form but of the greatest value in 
practice. In each disease he distinguishes two peri- 
ods : the first, dynamic, presenting only functional 
disturbance ; the second, organic, accompanied by a 
change of tissue. It is in the first period that the 
physician should use the most active means possible 
to jugulate the disease, or cause it to abort. From 
this Dr. Burggraeve educed his rule to give to an acute 
attack an acute treatment, and to repeat the small 
doses until the desired effect is obtained, independ- 
ently of the quantity of medicine administered, thus 
doing away with the ideas of maxima and minima, 
which have been regarded as axioms (especially when 
employing the alkaloids), and which are as great hin- 
drances to success as are the massive doses which are 
currently employed for certain drugs. 

Small doses facilitate the absorption of the medi- 
cine, and make it certain that the needed quantity 
shall not be exceeded. 

The disease may be considered as a resistance to 
the remedy, or a resistance of the human organism, in 
a state of disease, to the remedy. The dose should 



v iii PREFACE TO TEE AMERICAN- EDITIOK 

therefore be adapted to the morbid resistance. This 
adaptation can not be known beforehand : the organ- 
ism and the condition of the patient can alone indicate 
it. The dosimetric physician has thus the route he is 
to follow clearly traced before him by the imperious 
indications of the facts in the case. He is in no danger 
of an imprudence by giving too much of the remedy, 
because he stops it or gives it less frequently when the 
useful effect he aims at begins to be accomplished ; 
and, on the other hand, he is not held back in his 
treatment by timidity, for he is guided by Dr. Burg- 
graeve's invaluable rule to continue giving the remedy 
until a useful or sufficient effect is obtained ; that is, 
a result which is sensible to the patient or appreciable 
by the physician. One granule too few may prevent the 
desired effect; one granule too many, by increasing 
that effect a little, can not do harm. 

As Prof. Laura says, in his "Journal Dosime- 
tria" : " Observation and experimentation are thus the 
two masters that never deceive. The experimental 
method has become the sovereign method in medicine." 

There can be no exact treatment without an exact 
clinical knowledge and an exact remedy. The exact 
remedy can only be had in the simple principles of the 
medicinal plants, i. e., in their alkaloids. Dr. Burg- 
graeve found that, by administering the necessarily 
small doses in a liquid form, there was a too rapid ab- 
sorption by the mucous membranes of the throat, etc. ; 
he therefore adopted the form of the granule, and he 
applied to a well-known and very skillful pharmacist, 
M. Ch. Chanteaud, of Paris, to assist him. M. Chan- 
teaud prepared the granules containing the different 
alkaloids. They are easily soluble, and are unalterable 



PREFACE TO THE AMERICAN- EDITION. \ x 

except when exposed to dampness. Each granule con- 
tains, according to the case, a half-milligramme, or one 
milligramme, or one centigramme of the active sub- 
stance. These quantities correspond to j^-, and ^ 
and about \ of a grain English. 

These granules are composed solely of the alkaloids 
mixed with and protected by sugar of milk. They are 
rapidly dissolved by the juices of the stomach, and are 
absorbed within ten or fifteen minutes, so there is no 
possibility of an accumulation, as sometimes happens 
with pills ; especially as there is, in the dosimetric 
treatment, a lavage intestinale every morning by 
taking a teaspoonful or less of Sedlitz Chanteaud 
(neutral sulphate of magnesia), which has the triple 
good effect of acting on the digestive tube, on the 
kidneys, and on the skin. 

D'Oliveira Castro writes (in another book) that the 
dosimetric granules are of such purity and so regular 
in their action that too great praise can not be given 
to M. Chanteaud for the courage with which he de- 
voted himself to the reform of Dr. Burggraeve, but still 
more for the constancy with which he has maintained 
the purity of his products. 

There are, unfortunately, many imitations, and some 
very poor ones, now offered for sale both in Europe 
and America ; and their use would bring discredit upon 
dosimetric treatment. The sole agents in the United 
States for the Chanteaud granules are Fougera & Co., 
of 30 North William Street, New York. 

These granules do not deteriorate if kept from 
humidity. D'Oliveira Castro states that some of them 
which he had on hand for six years preserved intact 
all their organoleptic and therapeutic properties. 



x PREFACE TO TEE AMERICAN EDITION. 

The hesitation which, many physicians show to 
using the alkaloids in their general practice seems 
strange when we consider that, for their hypodermic 
injections, they employ exclusively these active sub- 
stances that are chemically defined ; and that, for this 
purpose, they never use extracts, decoctions, or elec- 
tuaries. Why should the cellular tissue be given the 
prerogative of a treatment by simple substances, easily 
absorbable, while the intestinal mucous membranes 
are rudely attacked by gross and irritating substances, 
whose absorption is often difficult % 

If their hesitation proceeds from the fact that they 
regard these alkaloids as poisons, this may be justified 
to some extent, for the reason that in allopathic prac- 
tice there are numerous examples of poisoning by their 
use ; but not one case can be cited in dosimetric prac- 
tice. 

There are now in Europe more than three thousand 
physicians who use the dosimetric treatment ; many of 
them have done so for several years, and, in the thou- 
sands of cases which they have reported in the dosi- 
metric journals, there is not one case of poisoning by 
the alkaloids. As Prof. Laura says: "In dosimetry, 
poisoning is materially impossible." 

The dosimetric medicaments should always be given 
by small successive doses, proportioning the dose to 
the tolerance of the patient, and they are to be sus- 
pended or given less frequently as soon as the physio- 
therapeutic effect is obtained ; consequently, a toxic 
effect is never reached. 

Dr. Burggraeve says it is only the abuse of these 
medicaments which provokes a toxic action. 

Dr. D'Oliveira Castro shows elsewhere how a patient 



PREFACE TO TEE AMERICAN EDITION. xi 

may take successively or at proper intervals more than 
sixty granules of aconitine without feeling the physio- 
logical effect, and still less any toxic effect, or more 
than toxic. 

In order that therapeutics should derive the great- 
est benefit from the use of the active principles of 
plants, it was necessary that Dr. Burggraeve should 
teach the profession how to use them, not only with- 
out danger, but in the most profitable way. 

He has thus deserved the title of Reformer of 
Therapeutics. 

About fourteen years ago he founded a monthly 
journal in Paris, "Le repertoire universelle de mede- 
cine dosimetrique." 

It contains the report of cases treated dosimetric- 
ally by allopathic and other physicians in all parts of 
France and of some other countries. 

There have subsequently appeared similar dosi- 
metric journals in Italy, Spain, Portugal, England, and 
Holland, and very recently in New York. 

Dr. Burggraeve has written many important books 
on the subject ; a list of some of them is given in this 
work ; and, although now in his eighty-second year, 
he is still an indefatigable writer and a hard worker. 

A most useful book is the " Compendium de Mede- 
cine Dosimetrique," by Dr. Van Renterghem, of Goes, 
Zealand. It is chiefly devoted to the therapeutics of 
the active principles of plants. 

Prof. Laura, of the School of Medicine of Paris, has 
in press a treatise of " Pharmacodynamie Comparee." 
He says that his life for twenty -five years has been 
devoted to the hospitals, to instruction, and to his 
private practice. During eighteen years of this time 



xii PREFACE TO TEE AMERICAN EDITION. 

he followed the rules of the regular school of medi- 
cine, but for the past seven years he has devoted him- 
self to the study and practice of dosimetry exclusively. 
This work, treating of comparative pharmacology, is 
the fruit of his professional career. He compares the 
results of his later years with the earlier period of his 
practice. 

He says that he is profoundly and seriously con- 
vinced that this new dosimetric method is a grand 
progress in the science and art of medicine, that it re- 
stores to the physician an abiding faith in the curative 
powers of his art, while it spares him the dangers of 
an excessive treatment, and that it renders to suffer- 
ing humanity services much superior to those of ordi- 
nary medicine. 

The dosimetric method contains the germ of a per- 
fection which time and science will develop from year 
to year. Happy are those who are young in the medi- 
cal profession : they will see some marvelous things in 
therapeutics ! 

The present translation has been revised by Dr. 
Jules Grand, an eminent physician of the Ecole de 
Medecine de Paris, who has for some years followed 
the dosimetric practice. It has also been read and 
approved by the author, Dr. D'Oliveira Castro, who is 
a good English scholar. 



TABLE OF CONTENTS. 



PAGE 

Introduction (Dr. Burggraeve's preface) 1 

Prologue 7 

Prolegomena \ 11 

Life 13 

Disease — Causes of Disease — Morbid Symptoms or Effects — Morbid 

Elements 23 

Medicaments — Impressionability — Dosage — Concerning Curative 

Action 36 

The Therapeutic Plan 67 

Pharmacological Memorial of the Dosimetric Medicaments, with the 
Indication for Dosage, together with their Principal Properties 

and Applications 77 

Memorial of Diseases and the Principal Morbid Elements, with Indi- 
cations for the Corresponding Dosimetric Medicaments which 

would be most Useful 99 

Elements of Practice in Accordance with the Dosimetric System . 113 

ALPHABETICAL TABLE OF DISEASES. 

Abscess of the Liver. (See Suppurative Hepatitis, under H.) . .115 

Adenitis 115 

Albuminuria. (See Nephritis.) 116 

Alienation, Mental 116 

Amenorrhcea 119 

Amygdalitis 120 

Anaemia 123 

Anaemia, Cerebral 128 

Angina Pectoris. (See Valvular Lesions of the Heart, under H.) . 130 

Angina, Pseudo-Membranous. (See Diphtheria.) .... 130 

Aphthae. (See Aphthous Stomatitis, under S.) 

Apoplexy, Cerebral. (See Cerebral Haemorrhage, under H.) . . 130 

Apoplexy, Serous. (See Hydrocephalus.) 130 

Asthma 130 

Asystolia (Asystole). (See Cardiectasis.) 134 

Athrepsis. (See Pultaceous Stomatitis, under S.) .... 134 



xiv TABLE OF CONTENTS. 

PAGE 

Balanitis 134 

Beri-beri 136 

Blennorrhagia. (See Urethritis.) . 137 

Bronchitis . 137 

Bronchitis, Capillary 142 

Bronchorrhagia. (See Broncho-Pulmonary Haemorrhage, under H.) . 144 

Bubo. (See Syphilis.) 144 

Cancer of the Stomach 144 

Cancer of the Uterus 146 

Cardiectasis 146 

Catalepsy 148 

Catarrh, Epidemic 150 

Chancre, Infecting or Hard. (See Syphilis.) 152 

Chancre, Simple or Soft. (See Syphilis.) 152 

Cholera Morbus 152 

Chorea 174 

Cirrhosis, Hepatic. (See Interstitial Hepatitis, under H.) . . .176 

Colic, Hepatic. (See Biliary Lithiasis, under L.) 176 

Congestion, Cerebral 176 

Congestion of the Liver 180 

Congestion of the Uterus 188 

Congestion and (Edema, Pulmonary . . . . . . . 185 

Constipation 189 

Coryza. (See Rhinitis.) 194 

Croup. (See Diphtheria.) 194 

Cystitis 197 

Cysts, Hydatid, of Liver 197 

Delirium Tremens 198 

Dermatoses * . . 203 

Diabetes 207 

Diarrhoea 210 

Diphtheria 215 

Disease, Addison's 219 

Disease, Basedow's. (See Goitre, Exophthalmic) 286 

Disease, Tuberculous 221 

Dysentery 225 

Dysmenorrhea . 230 

Dyspepsia 232 

Emphysema, Pulmonary 238 

Encephalitis, Acute 239 

Encephalitis, Chronic 241 

Endocarditis. (See Pericarditis.) 243 

Enteritis .... 243 



TABLE OF CONTENTS. 



xv 



PAGE 

Epilepsy, 246 

Epistaxis .'..... 249 

Erysipelas 251 

Fever, Intermittent 257 

Fever, Puerperal 257 

Fever, Traumatic 262 

Fever, Typhoid . 265 

Fever, Yellow 273 

Gangrene, Pulmonary 275 

Gastralgia 276 

Gastritis, Acute 279 

Gastritis, Catarrhal 281 

Gastritis, Chronic 283 

Glossitis 285 

Goitre, Exophthalmic 286 

Gout 288 

Haemoptysis. (See Broncho-Pulmonary Haemorrhage, under H.) . 293 

Haemorrhage, Broncho-Pulmonary 293 

Haemorrhage, Cerebral 295 

Haemorrhoids 299 

Heart, Dilatation of the 301 

Heart, Valvular Lesions of the 301 

Helminthiasis 310 

Hemicrania 312 

Hepatitis, Interstitial 321 

Hepatitis, Suppurative 325 

Hydrocephalus 327 

Hydrophobia 329 

Hyperaemia, Meningo-spinal . 332 

Hyperkinesia, Cardiac s , 333 

Hypertrophy, Cardiac 336 

Hysteria .338 

Icterus 340 

Incontinence, Urinary 343 

Indigestion 347 

Infection, Paludal 348 

Infection, Purulent. (See Traumatic Fever, under F.) 350 

Laryngitis, Acute Catarrhal 350 

Laryngitis, Chronic 352 

Laryngitis, Stridulous. (See Acute Catarrhal Laryngitis, under L.) . 354 

Leucocythaemia 354 



TABLE OF CONTESTS. 

PAGE 

Leucorrhcea 356 

Lithiasis, Biliary 358 

Lithiasis, Renal . . 361 

Lumbago. (See Rheumatism.) 364 

Malaria. (See Intermittent Fever, under F.) 364 

Meningitis, Cerebral 364 

Meningitis, Spinal 368 

Metritis . , 369 

Metrorrhagia 372 

Migraine. (Same as Hemicrania, q. v.) 312 

Muguet. (See Pultaceous Stomatitis, under S.) 451 

Myelitis 374 

Nephritis 378 

Neuralgia 382 

Obliteration of the Arteries of the Brain 385 

Occlusion, Intestinal 387 

CEdema of the Glottis 391 

(Edema, Pulmonary 392 

CEsophagismus 392 

(Esophagitis . 393 

Orchitis 395 

Ovaritis 397 

Ozaena. (See Rhinitis.) 399 

Palpitations of the Heart. (See Cardiac Hyperkinesia, under H.) . 399 

Pancreatitis 399 

Parotitis 400 

Pericarditis and Endocarditis 401 

Peritonitis 404 

Phthisis. (See Tuberculous Disease, under D.) 406 

Plethora 406 

Pleuritis 407 

Pleurodynia. (See Rheumatism.) 413 

Pneumonia 413 

Pneumorrhagia. (See Broncho-Pulmonary Haemorrhage, under H.) . 419 

Pollutions. (See Spermatorrhoea.) 419 

Pseudo-Croup 419 

Purpura Hemorrhagica. (See Scorbutus.) 419 

Rhachitis 419 

Rheumatism 421 

Rhinitis 428 

Rubeola 431 



TABLE OF CONTENTS. X vii 

PAGE 

Scarlatina 435 

Sclerosis of the Brain. (See Chronic Encephalitis, under E.) . . 438 

Scorbutus 438 

Scrofula .440 

Septicaemia. (See Traumatic Fever, under F.) ... 442 

Spasm of the Glottis 442 

Spermatorrhoea 443 

Splenitis 446 

Stomach, Cancer of the. (See Cancer of the Stomach.) . . . 144 

Stomatitis, Aphthous 446 

Stomatitis, Catarrhal 448 

Stomatitis, Mercurial 449 

Stomatitis, Pultaceous 451 

Stomatitis, Ulcero-membranous 454 

Syphilis ' 455 

Tetanus 459 

Tuberculosis. (See Tuberculous Disease, under D.) . . . .461 

Ulcer, Gastric 461 

Urethritis 463 

Uterus, Cancer of the 465 

Uterus, Congestion of the 188 

Vaginitis. (See Urethritis.) 466 

Variola 466 

Vesania. (See Mental Alienation, under A.) 482 

Vulvitis 482 

Whooping-Cough 483 



INTRODUCTION 



The work of Dr. d'Oliveira Castro, which received 
the grand prize of the Dosimetric Institute for 1885, is 
the complement of the prize essays of Dr. Laura and 
Dr. Van Renterghem. Prizes were awarded to each of 
these three works : to the first, in connection with thera- 
peutics ; to the other two, in connection with materia 
medica. Together they form the ways and means of a 
well-adjusted medical budget. Practitioners will find 
in them all necessary directions for the treatment of 
acute and chronic diseases according to the dosimetric 
system. With such guides they should never have oc- 
casion to hesitate ; and they will escape the contradic- 
tions which the classic authors experience — of whom 
one might say, tot capita, tot census (as many opinions 
as there are individuals), if, like Julius C?esar, they 
give as an excuse the famous "Veni, vidi, mcV (I 
came, I saw, I conquered). 

The adversaries of the dosimetric system decry the 
simplicity of its means: " Always strychnine! aconi- 
tine ! veratrine ! digitaline ! hyoscyamine ! " As if the 
dosimetric medicaments were like the allopathic ones. 
With the latter the prescription must constantly be 
changed, because for the natural malady it substitutes 
an artificial one, as the word allopathy indicates. Do- 
simetry has also been reproached with the charge that it 
merely regarded symptoms, as if disease were an entity 
for which there were specifics — mercury standing for 
syphilis, salicylate of soda for articular rheumatism, etc. 
1 



2 ELEMENTS OF THERAPEUTICS AND PRACTICE, 

In dosimetry we regard the dominating and the 
varying — in other words, it is the treatment of causes 
and effects. If the first are often obscure, so that one 
might say, " Felix qui rerum poterit cognoscere causas " 
(happy he who will be able to comprehend the causes 
of things) ; the second, the effects, are constant. Symp- 
toms are the basis of treatment, as was well expressed 
by the celebrated author of ' ' Symptomatology, or Mor- 
bid Conditions " — " It is so unusual to cure, while it is 
always urgent to relieve." By the dosimetric system 
suffering can always be relieved and fever subdued, 
and it is upon this " jugulation " that the system is 
based. Munaret has said of it that it is an old fashion 
of the Greeks renewed, for it dated back to Hippocrates. 
If one shall object, ' ' How can one fight with an unknown 
enemy % " the answer would be, we are doing that most 
of the time, and this is the cause of the differences 
which prevail among classic authors. Open the work 
of Prof. Spring, for example, and you will see that, 
where he believed he was making the history of the 
medical science, he was pronouncing a criticism which 
was the truer because it was unconscious, for Spring, 
as a professor, was faithful to the "magister dixit" 
and he died of variola, a victim to his convictions that 
this disease can only be combated in its symptoms. 
D'Oliveira Castro, on the contrary, proves that the poi- 
soning of the blood in this disease may be combated, 
as the source of the trouble, by the sulphide of calcium 
as the dominant, and the defervescing alkaloids as the 
variant. That there are parasites, microbes, we do not 
deny ; but are they cause or effect ? In typhoid fever 
there are also proto-organisms ; will anyone say that 
this fever can not be arrested in its evolution % 

Where can these infinitely small organisms not be 
found % An enthusiast on the subject of microbes set 
up his microscope on a street-corner in London, and for 
a penny allowed each new-comer to examine a drop of 
water which, to the naked eye, was pure and limpid. 



INTRODUCTION. 3 

Under the microscope it swarmed with monsters which 
attacked and devoured each other. It was a sermon to 
the crowd against water, as effective as Father Mathew's 
sermons against gin. Could not one tell an equally 
alarming tale concerning the liquids of the allopathic 
pharmacies, covered with mold and in active fermenta- 
tion? Thus, to the microbes of the disease one must 
add the microbes of the remedy, while the alkaloids of 
the dosimetric system destroy both. 

The duration of the treatment is not a matter of im- 
portance ; that which is important is, that the patient 
run no risks. In dosimetry crises are not recognized, 
because vital reactions are battles in which the results 
are uncertain and contain an element of chance. 

These are the views which have guided Dr. D'Oli- 
veira Castro in the composition of his book. Being 
addressed to practitioners, it is sparing of theories, pre- 
ferring to go straight to the facts. Let us also believe 
that this book, as well as those of Laura and Van Ren- 
terghem, will be found upon the table of every physi- 
cian who desires to succeed in his cases, cito, tuto, et 
jucunde (quickly, safely, and agreeably). 

Dr. Burggkaeve. 



PROLEGOMENA. 

LIFE— DISEASE— MEDICAMENTS— CUKATIVE 
ACTION— THE THERAPEUTIC PLAN. 



PROLOGUE. 

WHE!sr a man takes the trouble to write a book, and 
has the courage to publish it, it must be to carry out a 
motive of some kind or other, whether it be the hope 
of applause, the desire to be useful, or the necessity of 
satisfying the conscience, in filling what one believes to 
be an important lacuna in literature. 

In the author's case, it is not an urgent desire to 
write which is responsible for this book, for he has had 
hardly time to experience any joy or satisfaction in 
writing ; nor has it been a desire for glory, for he is 
quite conscious of his insufficiency. 

It is a recognized fact, however, that there is in dosi- 
metric literature a lacuna of considerable dimensions. 
When the physician brought up in the precepts of the 
schools, but losing their illusions at each step in his 
practical career, feels skepticism and unbelief surround- 
ing him, clouding his faith in science, dampening his 
enthusiasm for struggling, and strangling that zeal 
which is an earnest of victory, he looks around in search 
of a plank for safety in the midst of this wreck — for a 
light which alone may illumine the most difficult and 
the least agreeable of all the professions. 

Outside of the walls of classic medicine appear, on 
one side, the structure of Hahnemann, battered and 
almost demolished by positive criticism, or expectation, 
seeking in vain to conceal its deplorable weakness ; and, 
on the other, the reform of Burggraeve, growing and 
filled with sap, ingrafted upon the experimental method, 
and nourished by the purest juices of chemistry and 
physiology. Under all these circumstances the physi- 



8 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

cian finds himself drawn along by reason, and compelled 
to yield to necessity ; but the novelty of the principles 
of the reform, the energy of its means, the strangeness 
of its results, all these arrest his attention and impose 
upon him a prudent reserve. The most natural way to 
inform one's self in regard to the practice of dosimetric 
medicine would be to read the books which contain its 
doctrines. But the truth is, that the dosimetric library 
still wants a treatise which shall teach the practitioner 
to draw practical consequences from the principles 
formulated by the venerable head of the dosimetric 
school. 

The "New Manual," written in 1877, is not only too 
much abridged on certain points, but is no longer on a 
level with the progress which has been reached by cer- 
tain disciples of this school, whose most effective work 
has been conceived and given to the world since the 
manual was published. 

Books on therapeutics age quickly, however positive 
their teaching may be ; for, whatever the utility of a 
medication or the efficiency of a medicament may be, 
improvements are always supposable. 

The new substances introduced into the therapeutic 
arsenal, or medicaments more effective than those al- 
ready known, new modes of administration, unforeseen 
results from combinations hitherto untried — all these 
constitute an important capital of forces which one can 
use against disease, and which the practitioner can not 
and ought not allow to remain unproductive. Periodi- 
cal publications appear and are forgotten, and do not 
always present the fruit of experience in its maturity. 
To be first on the ground, one is often content with a 
hastily prepared exposition. Besides, practitioners can 
not read everything, nor submit every novelty to the 
test of experiment. Hence the necessity of condensing 
everything which is worth preserving in print, and that 
is the plan which we have followed. Using alkaloids 
every day, we have employed them in all the diseases 



PROLOGUE. 9 

which we have been called upon to treat. This book 
is therefore only the exact reproduction of our daily 
practice, with the exception of certain rare diseases 
which we have had no occasion to treat, but for which 
we have formulated treatment in accord with the rules 
and indications of Burggraeve, or his most esteemed 
followers. Written from day to day, between profes- 
sional calls, this book is ever the narrative of our 
practice ; in that alone is its unity. We have always 
endeavored to be clear and truthful, though we might 
be neither wise nor learned. 

We hope that this effect will not be without some 
useful result, and we shall be satisfied if we shall be 
able to guide the first steps of those who desire to fol- 
low the paths of dosimetry after having left other 
schools with their illusions. Our satisfaction will be 
complete if this effort shall stimulate some one more 
competent than ourself to produce a more perfect and 
meritorious book. We do not dread criticisms, nor do 
we hope for eulogies ; our only ambition has been to 
be useful, and in pursuance of this end we have en- 
deavored to show the indications in each form of dis- 
ease, without any other regard for style than that of 
clearness. 

The plan of the book is a simple one. In the first 
part we give certain general considerations, to warn the 
neophyte against the astonishment which may be 
caused by the novelty of certain applications, or the 
boldness of certain principles which are far different 
from anything which he has hitherto been taught. In 
the second part we refer to the principal indications 
which are ordinarily presented in different diseases, and 
the means for satisfying them. In each chapter we 
insist upon the particular agents which are most useful 
to know, in such a way that the book may perhaps be 
considered as intermediate between a dictionary with- 
out the complete want of connection in the parts which 
a dictionary presupposes, and a treatise without the 



10 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

regular method of such a work. It is for this reason 
that the title of "Elements" has been chosen, in order 
to indicate that our ambition has been to serve as a 
guide for beginners, and a stimulus to those who can 
produce a more complete work than ours. 

This book is not intended to instruct beginners in 
medical studies, but only to enlighten the physician 
who desires to become acquainted with dosimetric treat- 
ment. All that is common to this system and regular 
practice is omitted, only the differences in the two 
therapeutic methods being described. The kind in- 
dulgence of the reader is desired. 

Dr. d'Oliveira Castro. 

Deqa de Palmeira, August 12, 1885. 



PROLEGOMENA. 

The disposition of the physician is to neglect the 
study of the philosophic problems which surround his 
science. It tends, on the other hand, to regard exclu- 
sively their practical application in so far as they are 
sanctioned by his own experience and that of others. 
Although he endeavors to disregard all speculative 
notions as to the origin of the phenomena which he 
encounters at every step, yet he can not help reflecting 
upon the principal points of his science, and investi- 
gating the phenomena which arrest his attention, and 
sharpen his curiosity in search of their first cause. 

The reasoning faculty, that endowment of all men, 
but especially of those who cultivate science, is as 
necessary to intellectual life as digestion to vegetative 
life. Bowed over the cadaver with scalpel in hand, 
opening and dissecting the tissues to seek in their 
changes for the causes of death, the physician must 
inquire in vain, must pursue his investigations in vain, 
for the supreme object of his search, life ; this has gone, 
never to be found. His inquiry as to what it is will 
never be satisfied. 

The lesions which have changed the tissues, the pro- 
found ravages which the organs have suffered, the 
strange degenerations which have altered their forms 
and their relations — these may explain the disease, with- 
out giving the supreme reason for death. Between the 
last moment of life and the first sign of death, what 
is going on which so condemns to decay a body which 
is endowed with motion, which stills forever a voice 
whose tender farewells break our hearts ? At this last 



12 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

moment have the lesions become so exaggerated as to 
destroy vitality, and to render the final struggle with 
the death-agony unsuccessful ? 

The physician who, at the pillow of the dying man, 
follows with painful curiosity the progress of this final 
scene, watching the heaving of the chest, the contrac- 
tions of the countenance, the convulsions of the limbs, 
the fall of the pulse, the elevation of the temperature, 
suddenly sees the chest at rest, the countenance calm, 
the limbs motionless ; the heart ceases to beat, and the 
body becomes cold. But can he, with the aid of all 
these phenomena, declare the secret of life, and the 
meaning of death % No, he can hear and observe, but 
in vain. The study of causes belongs to the reasoning 
faculty ; the discovery of the nature of causes to the 
domain of reason, aided and directed by logic. 

The clinician and the therapeutist can not be indif- 
ferent to the knowledge which pertains to life, for from 
this the knowledge which pertains to disease is derived, 
as well as that which pertains to health, and the means 
for restoring it. But it is the philosopher more than all 
others who should occupy himself with this study, for 
it embraces all nature, not being limited to man in a 
state of disease. But the physician is also a philoso- 
pher. He can not be disinterested in all the questions 
which are debated in the field of pure science. It is not 
only a satisfaction to his mind, always eager for truth, 
but it is a necessity for his practical work, which is 
never so bold nor so free as when it is illuminated by 
the light of wisdom and judgment. Empiricism may 
guide him for want of something better, but it is a blind 
guide, which leads now to a precipice, and again to an 
obstacle which can not be overcome. 

Unfortunately, when he interrogates science con- 
cerning life, he receives so many answers that his igno- 
rance is unenlightened. Opinions the most divergent, 
and schools the most opposed, have had their proselytes 
and their proficient advocates. But the independent 



LIFE. 13 

mind is not satisfied with any of them, nor is it content 
with following any. We would like to make an end of 
these divergences, once for all, and, with that end in 
view, to present an opinion which will defy all donbt, 
respond to all objections, explain all phenomena, and 
embrace all facts. Unfortunately, this can not be done ; 
and if we discuss the subject of life it is not with the 
pretension that we shall fully illuminate the subject, 
for even the greatest geniuses have failed in that re- 
spect ; it is only to keep our promise, and express our 
views sincerely and loyally. 

Before entering upon the subject of therapeutics, it 
is indispensable to have some sort of an opinion con- 
cerning life, disease, and medical agents. What we 
shall say, then, will be nothing but the expression of 
our views upon these subjects. 

The reader will accord to them whatever considera- 
tion they may seem to merit. 



LIFE. 

Life surpasses definition. One knows when he ex- 
periences it, and there is no one who does not know the 
difference between a living and a dead body. It would 
be useless work for a physician to probe such questions 
very deeply, were it not that a more accurate and com- 
plete knowledge of the nature of life than is ordinarily 
possessed fits him the better to interfere in connection 
with its phenomena. 

Pathology is a particular manifestation of physiol- 
ogy, just as therapeutics is of pharmaco-dynamics. To 
understand disease, and to be able to establish a rational 
and effective method of treatment, we ought clearly to 
understand the fundamental object of physiology, since 
upon this notion are based all those with which a phy- 
sician has to do. In order to give a precise idea of the 
nature of life, it will be necessary to take as a point of 



14: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

departure certain facts and principles which are recog- 
nized as axioms which do not require discussion. The 
best method, then, will consist in studying the most 
simple facts, and transferring the results of such study 
to conditions which are more complex. 

Whenever we can discover life, we shall always find 
that fundamental body, the cell, and an essential func- 
tion, nutrition, and these are definitely manifested by 
motion. Growth, assimilation, and elimination do not 
exist and can not be conceived of without the displace- 
ment of the matter of which these rudimentary organ- 
isms are composed. But as matter can not exist with- 
out motion, as everything in nature, from the vast stars 
which shine at the extremities of the universe to the 
invisible atoms which are agitated in the smallest grain 
of sand, is animated by motion, as everything lives, 
one might say that matter is the essential factor of 
life. 

Matter, some one will say, is inert ; but this inert- 
ness of matter ought not to be understood in the sense 
of immobility, but as the impossibility with which mat- 
ter finds itself endowed of changing, by its own power, 
its motion. 

We can conceive, without too great mental repug- 
nance, that an atom of matter can be in a condition of 
complete repose, but that which our reason refuses to 
admit is, that there can be bodies and forms, except as 
their inherent matter is unceasingly in motion. Imag- 
ine, for once, that motion ceases, and all nature will be 
destroyed, everything will return to chaos. The vast 
and eternal monotony of the desert would universally 
prevail, without a breath of air stirring a grain of sand, 
or a ray of light which would enable one to distinguish 
between the nearest object and the most distant star. 
We can conceive a void, but, while matter exists, we 
are compelled to allow it the property of motion, which 
is as inherent to its nature as substantiality, impenetra- 
bility, and inertia. 



LIFE. 15 

The notion of force results from that of motion. A 
force can not exist without motion, but it is rather the 
result and the effect than the cause of motion. Therein 
lies the apparently important difference which creates 
confusion between the idea of force and that of motion. 
Motion, being transmissible, has no need for the inter- 
vention of force as a cause ; but forces ought to be con- 
sidered as effects, which are also motions, for motions 
alone can produce motions. And just as motions are 
only causes of motion, so the effects of a motion are 
causes of other motions, from which it follows that 
forces may appear to be at once cause or effect of mo- 
tion. 

Matter can not be destroyed or annihilated. Matter 
always preserves the same mass and the same quality. 
The motions which animate this matter, and are sus- 
ceptible of modification, of augmenting energy, and of 
being transformed into new modes of motion, give way 
to new forms, to new molecular constitutions, to differ- 
ent chemical and physical properties. The force of in- 
ertia may be considered as true motion, as the essential 
quality of matter, and it should, preferably, bear the 
name of vibratility. All other motions are ingrafted 
upon this, being susceptible of augmenting it, but not 
of destroying it, because it is essential. The others 
are transmitted, augmented, diminished, decomposed, 
transformed. It remains permanent, while all the oth- 
ers come to an end and disappear. If, then, vibratility 
is the essential property of all matter, not alone of liv- 
ing matter, it must be concluded that the particular 
motion which characterizes life is an accessory contin- 
gent motion, of which we ought to search the origin 
out of that which constitutes matter itself. In consid- 
eration of what has been said, and what is to be said, 
we can eliminate from the vital principle all idea of 
force. In life there are no forces, there are motions. 
Still less ought we to admit the existence of a foreign 
substance in the organism which presides over vital 



16 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

acts, and born before the accomplishment of these acts, 
which it directs according to its fancy. The vital phe- 
nomena which we see can only be the resultant of vital 
movements which transpire in the inmost parts of or- 
ganized matter. Otherwise, conld it be comprehended 
how life conld be transported npon a minute portion of 
epidermis ; could leave one organism and be ingrafted 
upon another % Could one comprehend how a portion 
of tissue could be completely removed from an animal 
and, reapplied somewhere else, could resume its exist- 
ence as before % The transplantations of periosteum, 
teeth, of fragments of the skeleton, transfusion of blood, 
etc., would also be inexplicable if the foregoing propo- 
sition were not true. 

When one considers, on the other hand, that man, 
born from a simple cell, does not entirely die at one and 
the same instant ; that there is a capital difference be- 
tween the suspension of life in the noble organs and a 
similar condition in the less vital ones ; that in spite of 
the fact that the heart has ceased to beat, the lungs to 
respire, and the brain to think, the muscles may still 
be made to contract, the liver may persist in its work 
of assimilation, and other organs in their function of 
elimination, one can not help declaring that life is the 
sum of the elementary lives of the cells, all joined by 
the intervention of means of communication which se- 
cure all the cellular elements to each other, these means 
being principally the intercellular substance and the 
nervous system. Nevertheless, the problem thus sim- 
plified is not yet solved with sufficient clearness. It 
still remains under the same form, namely, what is the 
nature of the motion which determines vital phenom- 
ena, which is observed in the most simple organism — 
the cell % 

Let us see whether in the mineral kingdom we shall 
be able to find any analogous or similar phenomena, 
which will aid us in forming an approximate idea of 
what is meant by vital motion. 



LIFE. 17 

Suppose we take a bar of magnetic iron. Would, 
some say that there are in it currents and motions? 
Nevertheless, such is the case, for, wherever polarized 
forces exist, this polarization can only be accounted for 
by motions which are exerted in a x>redetermined way. 
If iron filings are distributed near each of its two poles, 
we can see them move and arrange themselves in more 
or less concentric lines around the two poles, forming 
a definite figure. To what is this result due % To a 
force independent of the iron which animates the entire 
bar \ No ; for, if we cut the bar, each of its fragments 
will reproduce the same phenomena as the original, 
with an intensity which is clearly the same. The force, 
therefore, resulted from a particular motion in each 
molecule of iron, the sum of the vibrations producing 
currents in a way which has been determined. The 
motion which accomplishes this result is not observed 
in all bodies, nor yet always in the same substance. 
On the contrary, a difference in temperature, a modifi- 
cation of the medium, an alteration in the chemical 
constitution of the bar, or the influence of motions of 
another kind, will suffice to augment or diminish the 
magnetic motion, and with it the motions of the bodies 
submitted to its action. This motion may even cease 
entirely, the material constitution of the body remain- 
ing the same, or, on the other hand, being altered by 
new chemical combinations. To the particular mode 
of motion which acts upon molecules of iron the name 
magnetism or magnetic vibrations is given without ex- 
plaining the way in which this motion differs from 
electricity, heat, or light. And this is sufficient, be- 
cause motion, being a property and not a substance, 
has no nature or essence. 

Vibrations may be counted or measured, but science 
has not yet been able to define them or otherwise to 
characterize them. Start a current in a voltaic pile, 
in the presence of a magnet, and what will be the re- 
sult % The electrical motion will stimulate the magnetic 
2 



18 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

motion ; the affinities of the substances which supply 
the current for the pile will be modified ; and if this 
motion be transmitted to an animal, it will have an in- 
fluence upon his power of contractility and sensibility. 
After a certain length of time it will be necessary to 
replace the constituents of the pile, and then it will be 
observed that crystallizations have occurred, the re- 
sults of chemical combinations and decompositions — 
phenomena which would not have occurred had elec- 
tric motion not excited them. Therefore, it will not 
be very difficult to understand how the phenomena of 
nutrition, of assimilation, and elimination, are pro- 
duced — phenomena which constitute the most univer- 
sal function of all living beings. 

It will suffice to conclude that matter in certain 
appropriate chemical and physical conditions is ani- 
mated by a certain motion to realize all these phenom- 
ena, the ensemble of which appears so incomprehensible 
to us. Life, then, is only an atomic vibration, a par- 
ticular modality of motion in matter. As in magnetism, 
electricity, heat, etc., we ignore the characters of this 
modality, and distinguish it only by its results, which 
we call vital, the ensemble of which bears the name of 
life, just as the simultaneous cessation of the most im- 
portant of them is called death. Around this opinion 
rally certain homoeopaths, certain organo-vitalists, and 
Burggraeve, the head of the dosimetric school, all of 
them regarding life as an organism animated by a par- 
ticular dynamic influence. 

What is the origin of vital motion, and what are the 
conditions which determine it % If life is a vibratory 
motion, and if matter is inert, vital motion can not 
begin to appear without first being transmitted. 

Now, the vibrations of bodies can only be produced 
in two ways : by transmission from other vibrating 
bodies, the motion of which passes into new bodies ; or 
by motions of another kind, which in consequence of 
certain resistances are transformed into vibratory mo- 



LIFE. 19 

tions. The laws of molecular vibrations are unknown, 
but it may be regarded as certain that they are under 
the influence of the medium, the matter, the dimen- 
sions, and the action of other motions. Thus we see 
friction converted into heat, and that into light, elec- 
tricity, magnetism, sensation, contraction, and work. 
Vital motion is transmitted to substances ingested in 
the process of alimentation, and incorporated by as- 
similation, and this is accomplished with the more 
readiness according to their vibratory power. Oxygen, 
one of the most magnetic of bodies, is indispensable 
both to animals and vegetables. The latter form the 
basis of alimentation for man, who could with difficulty 
adjust himself to a mineral regime, although this regime 
could contain all the chemical substances which he 
loses by assimilation. Vital motion in the individual 
is sustained by alimentation, which supplies it not only 
with the elements necessary to renew and increase the 
tissues, but also with strength, whether it be the direct 
strength which it carries within itself, or the indirect 
which it occasions by chemical combinations and de- 
compositions. Thus, fermentations constitute the first 
degree of that mtaUzation which animates the ingesta 
of the body, and which ought to facilitate their incor- 
poration into the organism. 

Vital motion is preserved in the species by the 
elimination of a living portion of the individual, which 
is animated with the vibrations characteristic of such 
species. Thus is explained, not only the perpetuity of 
species, but also heredity in races and families. The 
necessity for the participation of the two sexes in the 
accomplishment of reproduction is another argument 
in favor of the opinion which has been advanced with 
respect to life. The ovule is a simple organism which 
must be fecundated — that is, must receive an addition 
of vital motion, in order to be developed and become a 
complex being. Hybrid formations can not be con- 
ceived of as resulting from two vital principles which 



20 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

are blent in each other, but rather as the result of a 
vibratory motion which is different from the ordinary 
one. Life is a motion of the same nature as other 
physico-chemical forces, but different from forces stud- 
ied in connection with physics and chemistry. It 
should not be confounded with heat, electricity, or 
affinity, from which, however, it does not differ essen- 
tially. There are as many different modalities of vibra- 
tory motion in matter as in the ether interposed between 
the atoms of matter. Otherwise, how can one compre- 
hend that the seeds of plants and the eggs of birds must 
have certain conditions of medium and temperature, in 
order to germinate and be developed 1 How, also, that 
life in hibernating animals is suspended until that de- 
gree of external temperature returns which will again 
start into action their different organs and apparatuses ? 
How, too, the consecutive death of the different tissues 
in the same animal ? How can one explain the influence, 
which is so apparent, of a great number of external and 
internal agents upon living beings— an influence which 
is so profound 1 

From the foregoing the following definition of life 
may be accepted as a conclusion : Life is a particular 
vibration of matter giving rise to particular forms, and 
manifesting itself by functions which are only the 
phenomenal expression of this vibration, transformed 
into physical, chemical, mechanical, or psychical mo- 
tions. When this transformation is carried on rapidly 
in almost every part of the living individual, convert- 
ing vital motion into physico-chemical motions, it is 
called death. The elements in which life had been 
preserved die because they are not surrounded by the 
conditions which are essential to the performance of 
their functions. Life is not destroyed, however; its 
motion is not lost. Matter is disorganized, forms new 
combinations, and vital motion is converted into other 
forms of motion, viz., affinity, fermentation, liquefac- 
tion, etc. Consequently, death is the transformation of 



LIFE. 21 

that form of vibratory motion which is peculiar to life 
into other modalities of motion. Having thus ex- 
plained the origins of life, we can get for ourselves a 
clearer idea of vital phenomena. Vital motion, which 
animates each atom of a living substance, determines a 
certain polarization in the molecules, and hence it is 
not difficult to understand how cells are formed. As 
these are composed of different substances, their motion 
undergoes modifications which correspond to the sub- 
stances, and gives rise to functions which also differ. 
But motion is not located in the cell alone ; it also ani- 
mates the surrounding medium, its vibrations being 
transmitted to contiguous matter with a facility which 
varies with its vibratile power, and with the resem- 
blance which it has to the element which we are con- 
sidering abstractly. 

Therefore, a group of cells forming a more or less 
homogeneous tissue, may have a common life without 
the existence of any particular means of relation and 
communication between their different elements. Just 
as the particles of iron filings transmit to each other, 
by simple contact, the vibrations of the magnet to 
which they adhere, so the cells are in vital communi- 
cation by simple contact. But when the vibrations are 
modified, the motion no longer has a medium which so 
readily transmits its influence. There must, therefore, 
be special organs to receive the different vibrations, and 
convert them into motion of another kind, through the 
influence of a difference in material composition, and 
consequently of dynamic action, and thus institute the 
various functions. As the intervention of rheophores 
is necessary to convert magnetism into electricity, so 
the nervous system must intervene to transform nutri- 
tive motion, or the vibrations which result from it, into 
other vibrations which give rise to impression and sen- 
sation. 

Contractility, then, is nothing but the property 
which certain tissues possess of transforming vital mo- 



22 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

tion into mechanical work. In the physical world do 
we not see, in the same way, how heat produces expan- 
sion in bodies, which is made use of in so many ways 
to accomplish work of the greatest variety both as to 
its nature and its energy 1 Vitality is the sum of the 
motions which are peculiar to each vital element. It, 
therefore, bears a direct ratio to the number of those 
elements for each tissue. But as these motions can be 
converted into mental and mechanical work, into heat, 
affinities, etc., it follows that vitality diminishes in 
proportion to the work accomplished. In order that 
equilibrium be maintained, it is necessary that it be 
furnished with new potentialities of dynamic force — in 
other words, with elements which are susceptible of 
receiving a reserve supply of the vital influx for which 
they will be the more fitted as their energies approach 
the nearer, in point of resemblance, to the organism 
in which they are about to enter. Among the vital 
phenomena we shall also find psychological ones, but 
for the present we shall not enter this labyrinth, and 
the more willingly, inasmuch as the physician may put 
such obscure questions aside, without suffering in his 
practical work. The nature of these phenomena is 
most complex. The brain is the particular organ which 
concentrates all the activities, and which has the power 
of transforming all sensations into perceptions, into 
consciousness. It is, in a certain way, the general 
organ of the senses. Thought, the will, are thus the 
wonderful and incomprehensible result of vital vibra- 
tions, just as the electric light is the soul of electricity ; 
a light of the original mode of which we are ignorant, 
a light which is different from all other lights, a vibra- 
tion different from all other vibrations. The brain can 
think and perform its functions only under certain 
physical conditions. A slight change in its circulation, 
an imperceptible lesion in its structure, may modify 
all the psychical phenomena. The concentration of 
all transmitted motions, the conflict of all these modi- 



DISEASE. 23 

fied vibrations in the track of nervous conductors, give 
as a result a particular motion, which is called the 
soul. Just as a lens, concentrating rays of light, pro- 
duces at its focus wonderful phenomena, so the brain 
can be conceived of as a concave mirror, where all cen- 
tripetal impressions are focalized, and upon which are 
reflected and radiated all centrifugal vibrations. 



DISEASE. 

After the foregoing statements, it is easy to under- 
stand that each cellular element lives, not only in its 
own life, but also in that which animates all the other 
elements which are near enough to be moved in the 
same sphere of activity, and even in those which are 
remote, with which it has certain communications. 
There is, then, a reciprocal action of element upon ele- 
ment, of such a character that, when one is perturbed, 
its echo is perceived in all the others. Life, considered 
as a force composed of the entire ensemble — that is to 
say, vitality — is therefore the resultant of elementary 
energies, and the elementary energies are, in their turn, 
resultants in which the general resultant appears as a 
factor. But, as the organism can not escape from in- 
fluences exerted upon its vitality by the external me- 
dium, which is constantly varying, and the internal 
medium, which is equally inconstant ; as, on the other 
hand, vital phenomena are constantly changing the co- 
efficient of vitality of the organism which serves for 
their field of operation ; as, finally, vital motion varies 
necessarily with the inconstant material constitution of 
the anatomical elements — it follows that vitality changes 
every instant under the influence of as many different 
causes as act upon it in a modifying manner. 

The first law of living bodies is, therefore, the con- 
tinual absence of equilibrium. But, in spite of all the 
influences which necessarily modify the coefficient of 



24: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

vitality, the want of equilibrium is so little manifested 
that neither in living matter, nor in the motion which 
animates it, does it give rise to trouble which is per- 
ceptible to the individual. Thus, the functions are 
executed with regularity, notwithstanding the more or 
less periodical oscillations which characterize all vital 
acts, the ensemble preserving an apparent equilibrium ; 
for not all the functions are either in action or at rest 
at the same time. This apparent equilibrium consti- 
tutes the condition of health. 

When a function is performed with an expenditure 
of an excess of vital motion, and in such a way that 
other functions are prejudiced, or when its work re- 
quires too much time for its accomplishment, equilib- 
rium can no longer be maintained, the coefficient of 
vitality diminishes, and we have the beginning of dis- 
ease. 

Between health and disease there is, primarily, no 
other difference than a marked want of equilibrium, 
which can not be quickly restored ; the question is one 
of degree and of time. 

Disease, at its beginning, is therefore a notable and 
permanent diminution of the vital motion which ani- 
mates the organism. All the causes which antagonize 
the production of this motion are causes of disease. 
But as motion can never increase, except for a very 
short time, without a material substratum, it follows 
that all diseases have an asthenic element. When an 
augmentation of vital vibrations is produced by any 
cause whatsoever, the excess is immediately trans- 
formed into other mechanical, chemical, or physical 
motions, and equilibrium is rapidly restored. The 
easiest way to produce a notable increase of vitality 
would be to excite strychnism. This is manifested by 
convulsions — that is to say, an excess of vital motion is 
transformed into mechanical work, heat, and chemical 
reactions, which immediately consume the excess of 
vitality, and re-establish equilibrium, or may even 



DISEASE. 25 

produce a want of equilibrium of an opposite char- 
acter. 

Those who admit the existence of hypersthenic dis- 
eases are victims of an illusion, and mistake the appar- 
ent for the real. Living matter may be incited and 
excited. Incitability is the property which it possesses 
of increasing, to a certain point, the number or the in- 
tensity of its vibrations. This functional impulse re- 
sults in a growth of substance, which establishes, in a 
permanent manner, this gift of vitality. Incitation is 
joroduced in a slow and secret manner, but yields a 
lasting result. It can only be realized by alimentation, 
and by weak but prolonged hygienico- therapeutic 
means. Excitability is the power of displacing vital 
motion, which increases with excess at some points, 
while it diminishes at contiguous ones. Excitation is 
not an increase of force, nor a means of profit nor of 
wealth. It is a loan which is made by one part of the 
organism to others. And, as this increase of motion is 
rapid, and as matter can not sustain it, because it has 
not augmented to a parallel degree, it is transformed 
into other modalities of motion, in order to re-establish 
equilibrium. The borrower is no richer than before, 
while the lender is impoverished, because nothing is 
given back. The final result of excitation is conse- 
quently, in all cases, an impoverishment of vitality and 
hyposthenia, and the diseases which show a great ex- 
penditure of force are the result of excitation, and are 
never characterized by hypersthenia. 

The sum of vital motion appertaining to each indi- 
vidual being insusceptible of rapid augmentation, un- 
less the substance which is to receive the excess under- 
goes organization, it follows that all diseases signify 
diminution of vitality. Consequently, everything which 
causes a diminution of vital motion is also a cause of 
disease. 

Now, as this motion diminishes by the removal of 
material substance, by its transformation into other 



26 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

motions, and by certain modifications of the medium in 
which, it is accomplished, it follows that vitality may 
be attacked by losses of material — for example, haemor- 
rhages, mucous and purulent discharges, etc.; by the 
various modes of transformation of motion — for exam- 
ple, exercise, hyperthermia, moral emotions, intellectual 
work ; by meteorological perturbations of all kinds, 
such as barometric, hygrometric, therm ometric changes, 
etc. 

The organism, though exposed to so many influ- 
ences, feels them all, and, if the want of equilibrium is 
not pronounced and is soon re-established, it will con- 
tinue to thrive, being governed by their intensity and 
its own coefficient of vitality, or, if the test be very long 
or very severe, it will show a tendency to weakness ; 
and it will become actually sick if the derangement be 
too great to remain unnoticed. 

It is surprising, indeed, that the organism is not 
oftener diseased, exposed as it is to so many vicissi- 
tudes, and that it almost always recovers its equilib- 
rium. 

Experience has taught man how to attenuate the 
most of the causes of disease, and to prevent their 
effects. 

Hygiene, which we all follow mechanically, and the 
mobility of the vital energies, which rapidly restores 
harmony among the vital forces, distributing them with 
regularity, explain how man can resist so many causes, 
both internal and external, which constantly threaten 
his health. 

From the foregoing considerations it may be con- 
cluded that disease, in its initial phase, is always a 
perturbation, or rather a diminution, of the dynamic 
influence which animates the organism. 

But this dynamic perturbation compels an alteration 
in the molecular constitution, in the atomic grouping 
of the living matter. Modifications of nutrition coin- 
cide with this alteration of matter, changing the form 



DISEASE. 27 

and the work of the cells. The elements first attacked 
influence those which are contiguous, and these, in 
their turn, influence the general vitality. This altera- 
tion is resented by the nervous centers, which, on their 
part, react upon the entire organism, sending out ab- 
normal vibrations which further disturb the regularity 
of the intimate phenomena of life, and give, as a final 
result, lesions of substance and structure which modify 
the local life and the general vitality. Therefore, no 
perturbation can remain local or simple. It soon be- 
comes the cause of a circle of perturbations, which are 
constantly increasing in number and in complexity. 
The most insignificant cause, hardly able at the begin- 
ning to produce a dynamic perturbation, may become 
the point of departure for numerous dynamic and so- 
matic morbid effects. 

Diseases, then, are primarily dynamic, but soon be- 
come material, because the dynamic influence can not 
be isolated from matter, and because its modalities 
forcibly influence the organism. There are, therefore, 
dynamic and somatic diseases. All diseases must be 
of both kinds, and in all there is only a predominance 
either of dynamic perturbations over the material ones, 
or the reverse. In the first phase of acute diseases, per- 
turbations of vital motion predominate, the material 
lesions being still insignificant. 

If the equilibrium is not re-established, the vital per- 
turbations are superseded by modifications of structure, 
and organic lesions are constituted. As lesions develop 
from other lesions, however, and as the changes in vital 
motion engender other changes, disease is not entirely 
established, as long as this ascending progression of 
morbid dynamico-somatic effects lasts, and also this 
first period of abnormal evolution in which the organ- 
ism finds itself, and which does not end without estab- 
lishing an equilibrium — that is to say, a stationary 
period. But this equilibrium, which is out of harmony 
with the natural arrangement of the organism, and with 



28 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

the influences of external agents, is quickly disturbed, 
and then a new phase of difficulty is seen, the evolution 
of which may be accomplished in the direction of dis- 
ease, which may become aggravated and complicated, 
until it results in death ; or in the direction of health, 
which improves as the ensemble of the perturbations is 
simplified and diminished. When equilibrium is re- 
stored, convalescence begins, which is equivalent to the 
incorporation of a new substance, this process continu- 
ing until the organism has recovered its normal sub- 
stance and vitality. 

Five periods can be recognized in disease — the dy- 
namic, the preparatory, the constitutive, the period of 
reparation or of disorganization, and the period of con- 
valescence or of death. The dynamic period lasts from 
the first perturbation of the vital motion until the ap- 
pearance of perceptible lesions in the organized matter ; 
it becomes preparatory when these lesions evolve, call- 
ing forth secondary, tertiary lesions, etc.; it is constitu- 
tive when this evolution is completed, as long as this 
state of abnormal equilibrium persists ; the fourth pe- 
riod begins when the abnormal equilibrium is destroyed, 
the perturbations now increasing until they become 
incompatible with life, now diminishing until there is 
a return to stable equilibrium, compatible with health. 

CAUSES OF DISEASE. 

Diminution of the vital motion constitutes the first 
act in the morbid series, the essential primordial cause 
of all disease. But, as this diminution may be excited 
in different ways, the causes of disease may be classi- 
fied into different categories or groups, which are all 
reducible to three. 

The first group includes all the dynamic agents, 
whether chemical, physical, mechanical, or vital, which 
have an influence upon the organic dynamic principle. 
Therefore, heat, light, sound, muscular work, the work 
of the intellect and emotions, may all influence vitality, 



DISEASE. 29 

by giving rise to different diseases characterized by 
the morbid effects which are successively produced. 
Almost all the acute diseases belong to this group. 

The second group includes material agents, and, in 
addition, those which primarily excite modifications in 
the material composition of the organism. So the want 
of proportion between the elements which are neces- 
sary to the organism, and the quantity of the elements 
of repair which is furnished to them ; the defective 
elimination of certain products, the incorporation of 
certain insoluble and non-assimilable substances, trans- 
form the material constitution of the organism, produc- 
ing alterations which are now imperceptible in the 
vibratory motion, but which sooner or later become 
appreciable when alterations of matter are extended or 
multiplied. This is the genesis of many of the chronic 
diseases. The third group embraces the dynamico- 
material causes — that is, that class of agents the ac- 
tivity of which is exercised not only by their presence 
in the tissues, but by the dynamic modifications which 
they cause there. The invasion of the organism by 
living agents, whether animal or vegetable microbes, 
bacteria, the entire class of parasites, realizes this two- 
fold order of perturbations. In this last category may 
be classed the alkaloids and other principles which do 
not merely change the material constitution of the 
tissues in which they are deposited, but excite di- 
rect dynamic perturbations by virtue of their energy. 
Among all these causes, some act instantaneously or 
within a short period, and give rise to a simple vital 
perturbation which either disappears on account of com- 
pensatory action by other motions, or is transformed 
into successive effects, and produces a disease which 
retains no trace of the nature of the exciting agent. 
Such are the diseases which are caused by cold, inso- 
lations, results of moral emotions, etc. Others, on the 
contrary, continue for a very long time, and give rise 
to successive perturbations which change their form 



30 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

and physiognomy according as the susceptibility of 
the individual is modified by the first perturbations. 
These perturbations always preserve, among their con- 
stitutive elements, the causal one — in other words, 
among the secondary, tertiary, etc. , morbid effects, the 
primary perturbation can always be recognized, being 
maintained by the permanence of the cause. This con- 
stant element, or this permanent perturbation, which 
is excited by the cause, is antagonized, in dosimetry, 
by the dominant, appropriate action being based upon 
the aphorism sublata causa, tollitur effectus (when 
the cause is removed, the effect will disappear). The 
truth of this proposition is well seen in the parasitic 
diseases, for example, in indigestions, etc., diseases in 
which it is necessary to destroy the cause in order that 
the primary effects may cease, and with them the sec- 
ondary, tertiary, etc., ones. 

There are diseases in which it is impossible to over- 
come the persistency of the cause, and in which, then, 
one must counterbalance the primary effects. For ex- 
ample, since we are unable to dissolve a urinary cal- 
culus, we must endeavor to annul the spasm, the pain, 
the congestion, etc., which are due to the presence of 
the calculus ; and we must establish the dominant, not 
against the calculus itself, but against the causes which 
have made it grow. In other cases, after the disap- 
pearance of the original cause, there remains a perma- 
nent effect, which acts as the origin of all the others. 
Disease, being a chain of effects, may lose its first links, 
without any treatment which is directly aimed at them. 
Thus, an amygdalitis may be produced by cold, heat, 
fatigue, or by contact of an irritating substance. These 
causes will produce an inflammation which will persist 
long after the causes have disappeared. The dominant 
can have nothing to do with the original cause, which 
has disappeared from the scene of the disease, but it 
will operate upon the effect which remains, which is 
the cause of all the other effects. It will antagonize 



DISEASE. 31 

the element of inflammation, of which the cause may 
have been cold, or a direct irritation. 

The effects of these causes become in their turn the 
source of new perturbations, and the latter in their 
turn give rise to new morbid phenomena, which again 
are multiplied ; so that the disease, which started from 
nothing, is transformed after a longer or shorter period 
of time into an ensemble of diseases, of which the his- 
tory almost always involves difficulties which are in- 
extricable. 

Disease, therefore, is not a distinct entity of the 
organism in which it is established, though it may 
determine reactions which tend to destroy it. Disease 
is an ensemble of phenomena, created, either mediately 
or immediately, by a primary perturbation of the vital 
motion, or the matter in which it is located. This 
succession of phenomena obeys laws which control the 
resultant of forces or of motions. If the organism, 
having arrived at its greatest development, were in 
such a condition that assimilation and disassimilation 
exactly compensated each other ; if its work were al- 
ways the same, not exceeding what it could produce 
without disturbing the organo- vital equilibrium ; if 
external agents always operated upon it in the same 
way, and in a way which would be suitable for it — it 
certainly would never have diseases ; and not only 
would such an organism be without pain, but it would 
live indefinitely, as long as this ensemble of conditions 
was not disturbed. Unfortunately, life is, itself, one 
cause of disease, because, with its work constantly vary- 
ing, it is impossible to furnish to the organism the 
exact quantity of the elements of repair which are 
necessary. The organisms which have the most uni- 
form lives are also the ones which preserve it the 
longest, which explains the fact that certain forms of 
vegetation reach an age that man can never experience. 
In order that animal life be preserved for the longest 
possible period, vital motion must be almost suspended, 



32 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

and the organism be kept as free as possible from 
external influences. An hibernating animal, which 
realizes these conditions, to a greater or less degree, 
could remain in a condition of lethargy for a long 
period without any apparent modification of a morbid 
character. But is hibernation life? No, life is not 
repose nor immobility, but a conflict of motions ; life 
is motion. This is why disease is a modality of logic, 
and death a necessary consequence of life. 

SYMPTOMS AND MORBID EFFECTS. 

Whatever be the perturbation of the vibratory mo- 
tion which animates organized matter, it gives birth to 
alterations in the organic and dynamic state of the 
individual. These alterations may be compensated, and 
then the loss of equilibrium is unnoticed. But if com- 
pensation does not take place, they will engender new 
perturbations, secondary effects of the primary causes 
of the initial perturbation which the vital dynamic in- 
fluence has experienced. All these effects, as well as 
those which follow them, are morbid effects, but are 
not symptoms. The latter are morbid effects of which 
the sick person is conscious, or which are discovered 
by the physician in his examination. 

A symptom, then, is always engendered by a per- 
turbation of dynamic influence ; and just as the effect 
of motion is likewise cause of motion, so symptoms 
give birth to others, and these in their turn to yet 
others ; so that we ought to consider symptoms not 
only in themselves, but also, and above all, in their 
natural consequences. The first symptom of a morbid 
condition is a source of many others, and as this first 
symptom is the expression of a lesion which is rather 
dynamic than material, it becomes evident that it is 
principally at the beginning of morbid conditions that 
therapeutics has the best opportunity to interfere suc- 
cessfully, for it is more difficult for it to cure than to 
prevent. 



DISEASE. 33 

Besides, we always see certain symx^toms accom- 
panied by certain others, and we observe, in general, a 
constant succession in certain groups of symptoms. 
Does the frequent occurrence of this simultaneity and 
this order of succession, maintained by the invariability 
of physiological laws, justify the classification of these 
natural series of groups of symptoms into different 
species of diseases, as if they were entities characterized 
by typical properties ? Such a notion is entirely a false 
one. Disease is nothing but a new manner of being of 
the organs, which present either new phenomena or 
different modalities of normal ones. 

Herein lies the difference between clinical medicine 
and pathology : the latter shows us the species and 
genera of disease ; the former compels us to bear in 
mind that it is not disease, but diseased persons, with 
whom we have to deal. 

The morbid phenomena determined by numerous 
and different conditions vary unceasingly, according to 
the varying combinations of these conditions ; it is, 
therefore, impossible to refer diseased conditions to 
certain types which shall be invariable and uniform. 
If all individuals had organs constituted in the same 
manner, and endowed with the same dynamic energy, 
if climacteric conditions were the same for all, and all 
could be subjected to the same physico-psychical life, 
the same perturbation would then produce the same 
effects in all, in the same invariable order of succes- 
sion. In such a case there would be as many diseases 
as there are varieties of initial perturbations, and they 
could be classified as one classifies chemical reactions. 

But this equality does not and can not exist ; each 
case has its particular physiognomy, which distin- 
guishes it from all the others, and therefore justifies 
the clinical aphorism which has been referred to. 

Disease is made up of morbid symptoms and effects. 
But the relation of causality and dependence which 
unites these elements often requires that a system of 



34: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

treatment should take cognizance principally of symp- 
toms, not so much on account of the value of the 
symptom in itself, as on account of the other symp- 
toms which depend upon it, and the morbid effects 
which it may produce. Symptomatic therapeutics, 
which in dosimetry bears the name of the variant, is 
more important and more useful than many people im- 
agine. In annulling a symptom one does not confine 
himself to destroying its effect, and to simplifying the 
morbid condition, for by this means many others can 
be avoided, which would naturally and physiologically 
follow from the existence of the one which was to be 
suppressed. Symptomatic therapeutics is, therefore, 
not only curative of a portion of the disease, but pre- 
ventive, besides, of ulterior morbid phenomena, compli- 
cations, and aggravations. 

MORBID ELEMENTS. 

For the observant physician, disease is a combina- 
tion of symptoms which are linked together, distributed 
in groups, and determined by their filiations and their 
dependence. 

Every symptom represents a constituent element of 
disease, but all symptoms have not the same hierarchi- 
cal value, and do not all deserve to be placed in the 
class of morbid elements. There are principal and pri- 
mary symptoms, which give birth to others less impor- 
tant, which readily disappear with them. So pain, 
which may be only a simple symptom, is very often a 
true morbid element, since pain frequently engenders 
spasm, congestion, immobility, hyperthermia, insomnia, 
anorexia, etc. Remove the pain, and all its attendants 
will disappear. 

It is clear, therefore, that morbid elements are al- 
ways the basis of a therapeutic indication, since with 
them disappear also a great number of perturbations, 
and by simplifying disease we avoid ulterior complica- 
tions, diminish its gravity, and, at the same time, re- 



DISEASE. 35 

lieve the discomfort of the patient. The difficulty con- 
sists in recognizing, among so many perturbations, those 
which are the mothers of others, and, in the midst of 
groups of symptoms which subdivide in various ramifi- 
cations, to distinguish them by their families, in order 
to attack each one separately, at the time of the pri- 
mordial perturbation. One is therefore brought face 
to face with different and manifold indications which 
must be satisfied at the same time, not by favoring 
polypharmacy — that is, making use of many drugs for 
one disease — but, on the contrary, by using a single 
remedy for several elementary diseases, whenever it can 
be done, or at least a single remedy for each of their 
morbid elements. 

Suppose we have a case of congestive neuralgia. 
In connection with it there are two principal morbid 
elements which give rise to two independent series of 
symptoms — the pain which produces spasm, insomnia, 
etc., and the congestion which produces heat, oedema, 
and hypersecretions. If we simply antagonize the pain 
with morphine, the neuralgia itself will offer resistance, 
or will reappear after a short time ; but if we add aconi- 
tine, by which the congested condition is dissipated, 
we shall obtain a rapid and effective cure. This exam- 
ple well demonstrates the capital difference between 
polypharmacy, or the excessive use of drugs, which we 
condemn, and the proper association of medicaments 
which we must approve and advise. 

The morbid element is the cause of symptoms. But 
whether the symptoms are determined by a morbific 
cause, or by other symptoms, it often happens that the 
best way to antagonize the morbid element is to extir- 
pate or to neutralize the cause. 

It is, therefore, the causal or pathogenic element, 
the primordial one, which we ought to annul, as soon as 
it is recognized, and we have the means of destroying 
it. But, as the cause is not always present with its 
effects, as at other times we may fail to recognize it, 



36 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

and at others we may not know how to antagonize it 
successfully, we shall at times be limited to exerting 
our efforts against its first effects, its principal morbid 
elements. These are always, at the beginning, rather 
of a dynamic than a material character. Thus fever, 
pain, spasm, exaggeration of the work of elimination, 
excessive sensibility or contractility, are so many func- 
tional dynamic perturbations. They are so many phe- 
nomena of excitation and accumulation of vital mo- 
tion at the expense of certain parts, and from them 
follow hyposthenias, impoverishment of vitality (in the 
form of adynamias, anaesthesias, and paralyses), which 
we might easily avoid', were we to interfere as soon as 
they make their appearance, by means of def ervescents, 
calmatives, and antispasmodics, which are the principal 
agents for overpowering (jugulating) disease in its dy- 
namic and preparatory stage, before it is fully devel- 
oped, and before the dynamic perturbations are super- 
seded by material lesions. 

The study of symptoms, their hierarchical classifi- 
cation, their physiological interpretations — for some of 
them are the manifestation of latent though real morbid 
effects — will enable us to accurately determine the 
morbid elements, and to select those which should serve 
as the object of hygienic or therapeutic indications. 

Our practical work will always be more profitable 
in consequence of this work of analysis and synthesis, 
without which our system of therapeutics is tossed 
about at the mercy of a deceitful inspiration. It ought 
always to be based upon physiological premises fur- 
nished by minute study and reflection upon each case. 



MEDICAMENTS. 

Theee has been much discussion to establish a 
characteristic difference between foods, medicines, and 
poisons. This distinction has not yet been established, 



MEDICAMENTS. 37 

in spite of the most subtile reasoning, and it is impossi- 
ble to give an exact definition of each of these classes 
in such a way as to determine their differential charac- 
ters. In fact, just as it is difficult to accurately distin- 
guish health from disease, the entire difference residing 
in a different modality of the same phenomena, in di- 
versity of energy, and in the intensity of the vital acts, 
so between foods, medicaments, and poisons there is 
no other distinction than that which follows from the 
diversity of energy of their effects, and the intention 
with which they are employed. 

Foods, like medicaments and poisons, act upon liv- 
ing matter by their material and dynamic properties. 
Health is preserved so long as there is equilibrium of 
the vital motion ; but, in order to preserve this equilib- 
rium, it is necessary to compensate the losses which the 
motion sustains by means of other motions which be- 
come confused with it, and to re-establish the changed 
dynamic influence. Foods act to accomplish this end, 
and they have no other role than to furnish the sub- 
stance and force which the organism expends in accom- 
plishing vital acts. If they are not furnished in suit- 
able form, and at the proper time, the equilibrium is 
not re-established, the vital motion becomes insufficient, 
and an abnormal and morbid state is established, which 
may be readily remedied by alimentation, if its con- 
tinuance has not been too prolonged. Food, then, is, 
as it were, the proper medicament for those normal 
states in which there is want of equilibrium ; but it may 
also act as a poison if it is administered inopportunely 
and with excess. 

Disease, which is a condition of extraordinary want 
of equilibrium, therefore requires extraordinary means 
to restore equilibrium. From this point of view medica- 
ments are simply foods for the morbid state, for their 
sole object is to furnish the organism, either directly or 
indirectly, with means for preventing loss of equilib- 
rium, or for restoring it after it has been lost. Medica- 



38 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

ments which in their action exceed the requirements of 
the organism, increase the want of equilibrium already- 
existing, by increasing the perturbations, and so become 
an actual poison, just as would have occurred had a 
poisonous dose been given in the state of health. 

The medicament which accomplishes the desired end 
is, therefore, a substance which can furnish the diseased 
organism with the vital energy which is requisite for 
the restoration of the normal equilibrium. 

Just as foods are of different kinds, each kind being 
intended to satisfy a certain physiological want, or to 
determine certain modalities of motion, so will medica- 
ments vary with the diseases for which they are re- 
quired — that is, with the character of the dynamico- 
somatic alterations which the diseases produce. 

What essential difference is there between the phos- 
phorus which is taken into the stomach with the food, 
supplying nutriment "to the bones and the nervous sys- 
tem, and the phosphorus which is contained in the 
hypophosphites, and prescribed for such conditions as 
rachitis and nervous prostration ? 

What essential difference is there between the coffee 
which we drink every day to support the vital motion 
of the nervous system, and the strychnia which is given 
to stimulate the vitality depressed by disease \ 

In all these cases is there not a demand for an agent 
which shall satisfy a necessity of the organism % 

As all matter is animated by motion, and all motion 
can be translated into other forms, within certain de- 
fined limits, every substance and every motion may 
alike become a medicament. The secret of the action 
of drugs consists, then, in a conversion or transforma- 
tion of motions. 

Since vital motion appears to be limited to the or- 
ganism, and not transmissible by the ether, it is neces- 
sary, in order that there may be action on the part of 
medicaments, that they be in contact with living mat- 
ter. The latter animated by its special motion, and the 



MEDICAMENTS. 39 

former by their specific motion, as they conflict, give a 
resultant which is determined by the primitive action 
of each substance. But, as in all the tissues and all 
the organic elements we find neither the same material 
constitution nor the same vitality, it follows that the 
same medicament, in traversing all the tissues and all 
the elements, will not give the same results nor the 
same effects in all. 

Thus the elective action of medicaments is ex- 
plained, and the property which each possesses of pro- 
ducing an impression upon some organs or systems, 
and not upon others. 

Vital motion is modified by every substance which 
comes in contact with living matter. It is for that 
reason that alimentation does not differ essentially 
from medication. A more definite difference is that, 
while alimentation is always material, medication may 
be exclusively dynamic. Alimentation implies repair 
of expended substance ; medication implies at one time 
assimilation of matter, at another only modification of 
dynamic influence. Since dynamic changes constitute 
the primary character of diseases, medicaments ought 
to be modifying agents of vital motion, bound to re- 
store to it its original intensity. If medicaments, in- 
stead of simply modifying this motion, transform it 
into others, the loss of equilibrium will increase, and a 
toxic instead of a salutary effect will follow. The 
same substance, endowed with its peculiar energy, will 
at one time produce modification, and at another per- 
turbation. If the changed vital motion can utilize all 
the energy of the medicament, and transform it into 
vital vibrations, the vital motion will be modified as it 
becomes stronger ; but if the energy of the medica- 
ment, whether from its nature or the quantity used, 
transforms the vital motion into other forms, vitality 
will diminish and new perturbations will be developed. 
There is always, therefore, a limit to the action of a 
medicament beyond which toxic effect is apparent. 



40 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Within this limit the action of the medicament is pro- 
portional to the quantity used ; beyond it new modes 
of motion are developed, and the proportion is no 
longer preserved. 

Since all organic elements are interdependent, the 
primary action of a medicament npon a certain group 
of elements will be modified in a reflex manner by the 
influence of other groups. Therefore, the action of a 
medicament is not the same at the moment when it is 
first felt as it is subsequently. The modifications which 
are first effected have a bearing upon those which fol- 
low, and produce different results, according as new 
factors are introduced. The effect of the medicaments 
which depends altogether upon the substance used, 
and the dynamic condition of the organic elements 
upon which they are employed, differs, not only with 
different individuals, but even with the same individ- 
ual, according to the time of its application. Medica- 
ments may be classified into three groups : in the first, 
some, incorporating themselves in the living tissues, 
act indirectly upon the vital motion by the material 
modification which they produce upon the organism, 
since every alteration of substance causes an alteration 
of force ; while others, analogous to foods, by being 
assimilated sooner or later, increase the total of matter 
in -the individual ; yet others, which are true poisons, 
destroy a portion of the living matter, and only be- 
come useful by the disturbing modifications which they 
cause. 

The second group includes substances which, with- 
out becoming incorporated in the tissues, act only by 
contact, by the power of their dynamic properties, 
upon the motion which is peculiar to living matter. 
Some of them are dynamogenic, and increase the co- 
efficient of vital motion ; others are inhibitory, and 
diminish or suspend vitality. 

The third group includes all substances w T hich act 
like those of both the preceding groups. 



MEDICAMENTS. 41 

To the first group belong the metals, to the second 
the alkaloids, to the third the metalloids and the vac- 
cines (vaccins). 

As the vitality of the different tissues varies greatly, 
and as the want of equilibrium in the vital motion is 
not the same in each of them, it follows that the effects 
of medicaments are not felt in the same way in all parts 
of the organism, and that there may even be opposite 
effects in the different groups of organic elements. 
Therefore, it is not unusual to meet with dynamogenic 
effects by the side of inhibitory ones, so that one can 
obtain similar results by different means, and by effects 
which at the beginning are absolutely contrary to each 
other. 

In order to estimate an effect, it will not suffice to 
calculate the coefficient of general vitality ; it will be 
indispensable, in addition, to appreciate the particu- 
lar vitality of each organic element, in each of its 
factors, during the entire time in which the action 
of the medicament continues, and during the time in 
which this action is continued by successive vital 
modifications. These differences constitute impres- 
sionability. 

The action of medicaments being the result of their 
dynamic influence upon the vital motion of the organs 
with which they come in contact, and this result being 
appreciable or latent, manifest or invisible (although 
an effect is a result which is always susceptible of veri 
fication), it appears that the action of a medicament 
differs from its effect. The latter proceeds from the 
former, though this filiation or production may not 
always be direct. The action of a medicament may 
have ceased when its effect begins to be manifested. 
For example, a purgative effect may follow the admin- 
istration of belladonna or atropine long after their anti- 
spasmodic and exciting action upon the longitudinal 
muscular fibers of the intestine has disappeared. The 
action of a medicament always exists, whatever be the 



42 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

impressionability of the patient, but trie effect depends 
upon the impressionability of the subject, and the in- 
tensity of action of the medicament. 

In practical therapeutics one seeks only to obtain 
results. Since the conditions for obtaining them de- 
pend upon the agent which is used, the impression- 
ability of the patient, and the intensity of effect of the 
medicament, the therapeutic problem is resolved into 
its simplest expression : (1) By understanding the im- 
pressionability of the element upon which it is pro- 
posed to act ; (2) by determining the quality and inten- 
sity of the impression which is desired ; (3) by choosing 
the substance which is suitable for the production of 
this kind of impression, and calculating its activity — 
that is, bringing the necessary quantity into contact 
with the organ to produce the desired impression with 
the proper intensity. 

Therefore, the results depend essentially upon three 
factors — the patient, the medicating agent, and the 
dose. But, as one only uses those substances of which 
the medicinal properties are more or less well known, 
if one desires to effect a cure, one must determine, 
above all things, in each case : (1) The impressionabil- 
ity of the patient, (2) the proper dose which is required. 

IMPEESSIO^" ABILITY. 

In order to be cognizant of the entire impressiona- 
bility of the patient, we should know with exactness 
the impressionability of each tissue, in particular of 
each element upon which the medicament is about to 
act. But, as each element is in relation and communi- 
cation with many other elements, if not with all of 
them, the modification which is exerted by the medica- 
ment will differ at each instant, on account of the re- 
ciprocal influences which are established between the 
different animated elements. Hence the impossibility 
of determining, a priori, for the same medicinal unit, 
the resultant of the modifications which this unit will 



MEDICAMENTS. 43 

produce in a given element, and still more in the entire 
economy. 

Sick people, showing as they do the greatest variety 
both in their material constitution and their dynamism 
{dynamisme), may be said to have no characteristic 
which is equal in all ; more than that, the same sick 
person is not the same in successive moments. Trous- 
seau and Pidoux have related the experience which 
they had with antimonial preparations in 1831. In 
that year it seemed to be impossible to use them in 
large doses in the treatment of pneumonia. JSTot more 
than a gramme of the white oxide of antimony could 
be given with safety, and kermes mineral produced 
terrible accidents, in doses no larger than three to five 
decigrammes. Tartar emetic, however administered 
and attenuated as to the dose, could not be borne. 
Subsequently, this mysterious impressionability disap- 
peared, and sixteen grammes of the white oxide of an- 
timony, daily, were frequently given from the first day 
of the disease, two to three grammes of the kermes 
mineral, or one gramme of the tartar emetic, without 
associating with them any substance to mitigate their 
effect. In this way we can explain the different 
results which a substance produces, which may vary 
with the individuals and with the particular moment 
of life for each individual, without any regard to the 
dose. So extensive are the considerations upon this 
subject that opposite results are obtained from w^hat 
would ordinarily be expected. Bouchut comments 
upon this fact in the following manner : ' ' Medicinal 
properties are not, in fact, in the medicinal sub- 
stances themselves, as is commonly supposed. They 
represent the action of their particular characteristics 
in conflict with the living nature of each individual. 
Now, while this nature has general resemblances, it 
also has marked particular differences ; consequently, 
a medicament, which is always the same in its nature, 
will frequently meet organisms with different reactions, 



44 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

and will, therefore, furnish different curative reactions. 
Furthermore, it follows that medicaments do not always 
have the same results — for example, that which is a 
tonic for one person may not be for another. On the 
other hand, a remedy which we consider to be endowed 
with tonic properties, because by its use strength is 
increased and the tone of diseased organs improved, 
may cease to have those effects after a very short time, 
and may even exercise a debilitating action upon vital 
activity." (" Nouveaux Elements de Pathologie gene- 
rale," p. 124.) Fonsagrives expresses himself quite as 
positively : "A dose of a given drug may be tolerated 
to-day, and eight days hence it will not be. The dif- 
ference doubtless depends upon the different powers 
of absorption on the two occasions, and the different 
chemical conditions of the fluids in which the drug is 
dissolved, but above all upon the varying conditions of 
the nervous system. . . . And yet how many causes 
operate to complicate the physiological action of drugs, 
to attenuate or to increase it, to mask it or even to 
transform it altogether ! The different ages (of life) are 
not impressed in the same manner by the same drug — 
its different effect upon the different sexes is also no- 
ticeable. The temperament or the primary formula of 
health, the constitution, or its actual form, also effect 
modifications in the action of a drug. Besides, we 
must take into account the manner of life, the custom- 
ary food, the habits, etc. I do not mention, in addi- 
tion to these, conditions of a moral character which 
play an important part in the production of these infi- 
nite modalities, which an analysis, however skillful and 
delicate it may be, can not include in its ensemble" 
("Principes de Therapeutique generale," pp. 35 and 
281.) The same author continues : "One child's reac- 
tion may be represented by 1, if you give him a drop 
of laudanum, while another will, under the same cir- 
cumstances, be represented by 10. Every moment we 
are meeting with examples of this apathy on the one 



MEDICAMENTS. 45 

hand, and erethism on the other, with respect to every 
medicinal substance, which demonstrates that the 
weight of the body is an imperfect basis for establish- 
ing any rule of dosage. Impressionability to the action 
of medicines takes no account of the scales ; it rests 
upon facts of sensibility and life which are eminently 
idiosyncratic, which are measured in practice only by 
the results of the substances used, and for which there 
can be no arithmetical calculation. " ( " Traite de Thera- 
peutique appliquee," pp. 527 and 532.) The genuine 
homceopathists are troubled with this same difficulty, 
and La Pommerais says: "The question as to doses 
which will have a medicinal effect can not be estab- 
lished by a general principle, because it is subjected to 
an infinitude of individual conditions, from the most 
simple idiosyncrasy, to the best regulated constitution ; 
from the most lively sensibility, the most marked im- 
pressionability, to a sensibility the most dull, and sen- 
sations the most obtuse. In default of a fixed and 
invariable rule in respect to doses and the administra- 
tion of medicaments, which would be an impossibility 
in view of the variety of sick persons and sicknesses, 
the duty and the mission of every physician are to ap- 
peal to his own inspiration." 

The agreement is therefore unanimous. Experience 
confirms the conclusions which we have propounded, 
and we can assert that it is impossible to determine, a 
priori, tlie impressionability of a sick person. 

DOSES. 

What is a dose ? This term is usually accepted in 
two senses. It may mean the quantity of a medicine 
taken at once, or the quantity taken in twenty-four 
hours. To neither of these acceptations must there be 
rigorous adhesion. For, if it is impossible to ^k as a 
dose the quantity of chloroform which is taken with 
each inspiration, or the quantity of mercurial ointment 
which is absorbed by each act of friction, or the exact 



46 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



quantity of a purgative agent in each glass of purgative 
lemonade, we can not understand, on the other hand, 
why the accumulated doses should be estimated for 
each twenty-four hours, rather than for each forty- 
eight or each twelve hours. 

For active remedies the term is usually understood 
in the first of the two definitions ; but the confusion 
that exists well shows the want of precision and of 
clear knowledge which is indicated by the term. Not- 
withstanding this, there is nothing that is more impor- 
tant, for all therapeutics depends upon posology, and 
without it we should run the risk of going astray into 
the ethereal regions of the homoeopathic myth, or into 
the dangerous confines of toxicology. 

The only definition which can harmonize these two 
conflicting ideas is one which considers a dose as the 
quantity of a medicament which is intended to pro- 
duce a precise effect. 

Even this definition is somewhat vague, especially 
if we consider the necessity of expressing it in units of 
weight and measure. In fact, not only may the end 
for which the medicament was given fail of achieve- 
ment, but the effect may not be apparent, for that effect 
depends essentially upon the dose. There is, therefore, 
a vicious circle, in which one seeks to determine the 
effect by the dose, and the dose by the effect, a problem 
in which the product only serves to indicate to us the 
factors. This method of considering the dose is, there- 
fore, very arbitrary — in other words, is incompatible 
with the strictness which its object requires. But, in 
accepting it provisionally, suppose that one administers 
a dose of a certain substance in order to produce a cer- 
tain effect, and that the quantity which is necessary to 
obtain that result could be calculated in advance, would 
the effect appear, of necessity ; would the result be 
produced with certainty? Certainly not, even if we 
admit that the economy would always act in the same 
manner. As a matter of fact, there can be, and there 



MEDICAMENTS. 47 

always is, a considerable difference between the quan- 
tity of the medicament which is taken and that which 
acts at any given moment upon the part to which it is 
directed. There are, then, differences as to the degree 
with which medicines are retained, differences as to 
their solubility : there are those which take place at 
the time of absorption, and those which occur within 
the circulation, or while the medicament is en route. 
As to the first, we find that in certain cases of gastric 
irritability the whole, or nearly the whole, of the dose 
may be ejected by the act of vomiting. We know also 
that often, in such diseases as typhus fever or enteritis, 
the remedy may traverse the entire digestive canal 
without undergoing the least alteration, as has been 
recently stated, in a memorable discussion in connection 
with typhoid fever, before the Academy of Medicine of 
Paris, and as I have observed in some cases. 

The solubility of the dose is a matter of no less in- 
constancy, and one often finds at autopsies, in the folds 
of the intestines, large portions of medicinal substances 
which have failed as to the first condition in order to 
absorption. (Dr. Crassot, " Encyclopedic Medico-phar- 
maceutique," 1883, p. 708.) " There is a want of toler- 
ance," says Jaumes, " when a substance which has been 
taken in a solid form, the form of a pill, becomes so 
hard that it resists the dissolving action of liquids." 
("Traite de Pathologie et de Therapeutique generale," 
1869, p. 1096.) Absorption is eminently a variable con- 
dition, and it is only the fact that it is dependent upon 
life which makes it different from the phenomena of 
osmosis, and prevents us from counting upon identity 
as to results. It varies with the condition of the ab- 
sorbing surfaces, the density of the solution, the state 
of relative fullness or emptiness of the vessels, the de- 
gree of saturation of the secretions, etc. 

Finally, the passage of medicaments to their field of 
operation also varies with circumstances which it is not 
necessary to mention in detail. 



48 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

We learn, therefore, that medicaments, being com- 
pelled to experience so many vicissitudes before reach- 
ing their destination, can never have an effect which is 
proportional to the dose absorbed. Between the quan- 
tity of the dose which is employed and that which is 
used with advantage there is such a difference, and 
such a varying one, that, if we consider the dose as the 
quantity of medicine which is administered, we expose 
ourselves to the unlooked for, the uncertain, and the 
erroneous. 

Can we foretell with accuracy all the circumstances 
in nature which will have a bearing upon medicaments, 
so that we can estimate the loss which is experienced 
by the dose which is given % Can we in the most simple 
condition — vomiting, for example — estimate the quan- 
tity of the medicament which has been rejected, so as 
to replace it, and complete the necessary dose % And, 
if the result need not be mentioned in so simple a con- 
dition, what shall we do in the more obscure and com- 
plex ones % Nothing, and it would be foolish to attempt 
anything of the kind. What, then, is a dose, in its 
most rigorous acceptation % After what has been said, 
it is plain that it must be simply that portion of the 
medicament which acts. 

Now, as the object of administering a remedy is 
always to obtain a certain result, it may be said that 
the therapeutic dose is that portion of a medicament 
introduced into the blood which is capable of produc- 
ing a determined action. 

It would be absurd to admit that a result can be 
produced, whatever be the dose of the substance. 
Reason and observation show that the result always 
depends upon the dose. The homoeopathists them- 
selves seek a manifest result in their medication, for it 
is impossible to remove the dynamic influence (dyna- 
misme) of matter itself. Says La Pommerais: "The 
frequency of repetition should always depend upon the 
intensity of the morbid phenomena ; the more rapid 



MEDICAMENTS. 49 

the course of a disease, the greater the necessity for 
repeating the medicament until a result of a decided 
character is manifested." (" Cours d'Homceopathie.") 

One may be deceived in the interpretation of phe- 
nomena which are observed, but it is certain that one 
gives no remedy without hoping for some result from it. 

We have seen that every modification produced in 
the organism by a medicinal agent is called the action 
of a medicament. Whether this action be latent or 
visible, mild or violent, useful or harmful, it always 
exists when an agent enters into relation with a living 
element. It differs, then, from the effect. The effect 
is the action of a medicament carried to a certain de- 
gree, or intensity, and always giving rise to an apparent 
modification, whether that be physical, chemical, vital, 
or — with reference to results — curative. The effect, 
therefore, depends directly upon the dose. Without 
stopping to consider the effect in the element alone, we 
will study it in the organism, and, as the vehicle of the 
medicament is almost always the blood, and as most 
medicinal actions are accomplished by a modification 
of the nervous system, we may, in general terms, offer 
this principle : the effect depends upon the quantity of 
the remedy which affects the vitality of one or more 
nerve-cells, the remedy being transmitted by means of 
the blood- current. Thus we shall the better under- 
stand that, in addition to determining the effective 
portion of the dose, we ought also to take into consid- 
eration that portion of the medicament which is elimi- 
nated, and consequently can not affect a second time 
the cells to which it was carried by the blood before 
elimination occurred. In reality the dose varies with 
each systolic movement of the heart, because it de- 
pends partly upon the quantity absorbed and partly 
upon the quantity eliminated. Suppose a single dose 
to be introduced into the stomach, absorption does not 
take place all at once ; there will therefore be received 
by the blood a series of doses which will differ at each 
4 



50 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

moment as absorption goes on. If elimination is equal 
to absorption, the dose will be constant ; if the former 
be less active, the quantity of the medicament in the 
blood will increase as long as any of the substance 
originally ingested is not absorbed. If, on the con- 
trary, elimination is more active than absorption, the 
dose of the medicament in the blood will gradually 
diminish. 

If we can not calculate in advance the quantity of 
the medicament which will be absorbed, no more shall 
we be able, for similar reasons, to estimate that which 
is eliminated. 

As the active portion of the dose depends directly 
upon the two factors of absorption and elimination, 
and as these are absolutely indeterminable, the propo- 
sition is justifiable that it is impossible to calculate the 
active portion of any dose whatsoever. 

Experience is in accord with this conclusion. We 
know that at each step practitioners meet with sur- 
prises and with unforeseen results from inability to 
adapt the doses which have been prescribed to the ab- 
normal necessities of the patients. " That which will 
soothe one patient will excite another ; that which 
overheats may also refresh, just as that which refreshes 
may overheat. It is in this way that the same drug 
combines several properties. In support of this state- 
ment, let me call to your attention the tartrate of anti- 
mony, which is now purgative, now emetic, now dia- 
phoretic, in spite of posological precautions." (Muna- 
ret, "Le Medecin des Yilles et des Campagnes," 1862, 
p. 276.) 

" Other testimony could be added, but it will suffice 
to refer to the different idiosyncrasies, which are simply 
cases in which there is now great impressionability, and 
again an accumulation of doses ; extraordinary cases 
of tolerance, in which one or two grammes of opium 
have been given with impunity within a short space of 
time, or the wine of colchicum by the glassful at once." 



MEDICAMENTS. 51 

(Forget, ' ' De quelques Medicaments actif s administres 
a des Doses extraordinaires.") 

Such, is the extreme uncertainty as to the results 
which are to be obtained even with moderate doses, and 
also the variety as to the opinions concerning the prop- 
erties attributed to medicinal substances. There can, 
therefore, no longer be any doubt as to the perfect 
agreement of the teaching which is drawn from facts 
with the conclusions drawn from the principles which 
have been enunciated. 

We may, therefore, consider that the so-called maxi- 
mum and minimum doses have undergone condemna- 
tion. The facts which have been cited should long 
since have convinced physicians by their eloquent ob- 
stinacy that the principle of the maximum and mini- 
mum could not be considered the true rule for dosage. 
Common sense ought long since to have told us that 
the doses prescribed in the formularies are only based 
upon experience in certain cases, or upon experimenta- 
tion made upon animals. From such data, however, the 
first author who wrote upon the posology of different 
substances started, and others have simply copied after 
the first. If any fact went beyond the well-defined 
limits, it was wont to be explained by the defective 
quality or method of preparation of the drug, or by 
an idiosyncrasy so rare that one would not even take 
the pains to investigate the matter and see if it were 
really less rare than had been believed. 

It has been already remarked that a drop of lauda- 
num may have an effect in one person which might be 
represented by 1 and in another by 10; it has been 
observed that an occasional insufficiency of the elimina- 
tive organs multiplies the energy of the substances ab- 
sorbed, that poisoning may take place from minimum 
doses, and no appreciable effect be received from maxi- 
mum ones ; but, notwithstanding these facts, we seem 
to persist in preferring old methods, and in refusing to 
seek for the true significance of these numerous excep- 



52 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

tions. The bad results of this form of practice finally 
became so manifest that it was no longer possible that 
a remedy for such a degree of uncertainty should re- 
main undiscovered. 

What is that remedy \ Nothing could be more sim- 
ple : it is the old case of the egg of Columbus. If one 
desires to obtain the effect of a medicament, it must 
simply be given to the point when that effect is ob- 
tained. This discovery, which is so simple that it 
scarcely seemed a discovery, with an importance which 
is supreme, belongs to Burggraeve. Whether it is the 
fruit of genius or of common sense will be decided in 
the future ; perhaps it may be due to both. 

The entire system of Burggraeve starts from that 
point. But, in order that the effect may be produced, 
it is necessary that the desired intensity of the medi- 
cative action be not exceeded ; it is also necessary that 
the quantity of the drug in the circulation should not 
vary, by too much or too little, from the desired quan- 
tity. Furthermore, the absorption should be rapid, 
elimination readily accomplished, and the result 
promptly obtained. Hence the necessity of using small 
quantities, perfectly uniform in character, of energetic 
medicaments, which shall be readily soluble and per- 
fectly tolerated ; which, being introduced into the cir- 
culation, shall gradually accumulate in the blood until 
the active dose is reached. Hence the choice of alka- 
loids and other fixed principles, and of the granular 
form as a vehicle, in order that the patient may experi- 
ence the minimum of annoyance in the administration 
of small and frequent quantities. Clearly effect, under 
these conditions, means a result which is perceived by 
the patient or appreciable to the physician. Any other 
result must be illusory. 

Apart from this rule, there is only imagination ; 
there is nothing which is positive and mensurable but 
that which we can see and feel. Fonssagrives, whom 
we are pleased to quote, on account of his position, his 



MEDICAMENTS. 53 

age, his experience, his knowledge, and his critical 
spirit, qualities which establish his authority beyond 
conjecture and make him the representative of official 
science, repudiates the study of those intimate actions 
which are the most mysterious, for the reason that they 
are obscure and indeterminable, and advises that we 
attach importance only to those actions which are mani- 
fest or phenomenal, which have a result which can be 
perceived by the senses. ("Traite de Therapeutique 
appliquee," vol. ii, p. 506.) 

In ordinary practice doses are frequently measured 
without accuracy, and repeated without regard to any 
rule ; they often accumulate in the intestine, enter the 
circulation without our knowledge, or are eliminated 
without having produced any effect. Everything, in 
ordinary practice, conduces to such results. The vol- 
ume of the drug may be considerable, and it may be of 
a complex character, and not readily soluble. Its ab- 
sorption, therefore, is often irregular and illusory, while 
the large size of the dose may readily cause an accumu- 
lation in the blood, with serious and perhaps irrepara- 
ble consequences, if elimination is imperfectly accom- 
plished. This is the reason why many patients are 
sufferers from the use of substances which are appar- 
ently inoffensive, notwithstanding the fact that the 
most active substances will sometimes traverse the 
economy without producing the slightest perturba- 
tion. 

The most harmless substances have sometimes been 
objected to on the ground that they have a poisonous 
action. This is certainly true of them in some cases 
in which the physician has neglected to take into con- 
sideration the condition of the eliminative organs. In 
yet other cases the condition of these organs could not 
be foretold. The sulphate of soda, the salicylate and 
the nitrate of potash, which are usually regarded as 
harmless drugs, may give rise to the most unfortunate 
surprises. (See Fonssagrives, u Principes de Therapeu- 



54 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

tique generale," p. 148; J. Perreira, "Materia Medica 
and Therapeutics," vol. i, p. 504.) On the other hand, 
apparently toxic quantities of alkaloids are sometimes 
absorbed by patients without producing violent effects, 
in spite of the dread which is felt by those who dare 
not use them, and who forget that mildness and energy 
may go hand in hand. This irregularity in the effect 
of the alkaloids in some cases which are characterized 
by a very slight impressionability, or by an unusual 
readiness of the eliminative functions, can only be ex- 
plained by the method followed in administering them. 
The stupefaction which is manifested by those who do 
not practice dosimetry, at the effect of doses which are 
far superior to those which they have been in the habit 
of using, is not a new phenomenon. 

"It was a singular spectacle," says Jaumes, "for 
the practitioners who assisted the first dosimetrists, 
that a patient could endure without detriment and 
with positive profit considerable quantities of tartrate 
of antimony, the digestive function remaining almost 
undisturbed." ("Traite de Pathologie et de Therapeu- 
tique generale," p. 1102.) 

The same, or an analogous spectacle, is seen every 
day, but our adversaries do not seem to profit by the 
teachings of history. We must not lose sight of the 
fact that the dose is the quantity of the remedy which 
is present in the blood at any given moment, and that, 
for the same impressionability, the effect depends upon 
that dose. 

Let us now see what is meant by accumulation and 
saturation. 

Accumulation may be the result of the total quan- 
tity of the doses taken, or of the quantity of the doses 
which is used with profit by the economy. 

Accumulation by means of the doses taken is a result 
which can not be foreseen ; it may happen that several 
doses, given perhaps at long intervals, are added one 
to another, and retained in the digestive canal, where 



MEDICAMENTS. 55 

they may be absorbed or eliminated, entirely or in 
part. 

If absorption is total and continuous, the effect will 
exceed the calculations which have been made ; if the 
accumulated doses are rejected entirely, there will be 
no effect ; in yet other cases, the effect will depend 
upon the proportion between absorption and the activity 
of elimination. Accumulation from doses which have 
been efficient results from elimination which is insuffi- 
cient as compared with absorption. The activity of 
these two functions, however, is not susceptible of cal- 
culation ; we must, therefore, always proceed with very 
small doses, in order that accumulation may never be- 
come perilous. The medicament, as it accumulates 
little by little in the blood, will produce an intensity of 
action gradually noticeable, which will increase by de- 
grees until the effect — that is, the point for which we 
are striving — is obtained. When this effect has been 
obtained, it is time to suspend or to diminish the doses ; 
and, as the doses are very small, soluble, and readily 
absorbable, absorption will cease when the adminis- 
tration of the medicaments is interrupted ; likewise 
accumulation in the blood will be arrested, and the 
corresponding energetic action of the medicaments. 
Elimination continuing, the activity of the dose will 
continue to diminish until the remedy is entirely re- 
moved from the organism. It is, therefore, evident 
that, while in allopathic practice accumulation is an 
undesirable event, in dosimetry it is an advantage, and 
an indispensable one, because by it alone can the effect 
be obtained ; and, according as this effect is appreciable 
and proportionable to the accumulation, shall we be 
able to excite, increase, or diminish it, as the indica- 
tions present themselves. 

Aside from the accumulation of the doses, we may 
admit also an accumulation of effects, or medicinal 
erethism, in cases in which, the active dose remaining 
constant, the impression produced is maintained or is 



56 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

exaggerated by a repetition of the impressions cansed 
by the agent. In snch a case, also, dosimetry offers 
perfect security, because the effect is increased only to 
the necessary limit, since absorption is continually 
equal to elimination ; and, at the moment when absorp- 
tion ceases, the elimination continues, and the active 
dose is diminished in its turn, so the partial effects can 
no longer be increased. If, on the contrary, absorption 
exceeds evacuation, the accumulated effects will only 
produce the total effect more speedily. 

Saturation can be understood in only two ways : 1. 
Either it is the accumulation of the medicament in the 
blood in such quantity that its accumulation is no 
longer possible, from which one of two things happens : 
(a) an insufficient effect is produced (for, if it had been 
sufficient, the doses would not have been repeated until 
saturation), which will remain stationary, because the 
active dose can not be increased, absorption being sus- 
pended, and then this effect will indicate, ipso facto, 
that new doses would be of no use ; or (b) no effect is 
produced, and, as saturation prevents further absorp- 
tion of the medicament, we are reminded that we must 
try some other substance as a synergist. 2. Or satura- 
tion exists in the effects produced — that is to say, it is 
useless to increase the dose — the organism will no long- 
er react to its influence, and the medicinal energy will 
not reach a degree sufficient to produce the desired 
effect, still less to produce any phenomenon of an 
alarming character. 

But, though this element has given negative conclu- 
sions, some other element will respond to the indica- 
tions, and we shall thus be warned not to insist upon 
it. The effect that we seek after has not been pro- 
duced, it is true, but we are thus warned to be upon 
our guard. 

When this saturation of effects occurs, it may give 
rise to failure of a dosimetric treatment as well as of 
an allopathic dose. However, if the desired useful 



MEDICAMENTS. 57 

effect is not produced, but some unusual manifestation 
is apparent in its stead, which method will have shown 
the less foresight? Will it be dosimetry, which pro- 
duces an effect little by little with gradually increasing 
intensity of medicinal action, or the allopathic method, 
which roughly provokes it with all the force of its 
powerful doses? If this effect, which could not be 
foreseen, is an evil, under what condition shall we be 
able to control it with the greater facility \ Will it be 
when it exists at its maximum from the beginning, or 
when the evil presents itself slowly, and is aggravated 
only by our obstinacy and obtuseness ? The difference 
between the two methods is too evident for further com- 
ment. The only way, therefore, to proceed with accu- 
racy, with assurance, and without danger, is to give, at 
short intervals, small doses of simple substances which 
are readily soluble, and have clear and precise effects. 
In this way we can correct any possible variability in 
the given pharmaceutical preparation, uncertainty as 
to the activity of absorption, ignorance as to the state 
of elimination, and we can compensate for inconstancy 
in the vital impressionability. The different conditions 
may vary as much as they will, but we shall always 
reach the effect. Can this effect be injurious? We 
have already seen that it can not, for, in place of fol- 
lowing any arbitrary rule, in place of calculating the 
dose in accordance with the inflexible indications of 
the formularies, or our own vague inspirations, we allow 
ourselves to be guided by vitality itself. This element 
does not tell us how much of the medicament must be 
given in order to arrive at a precise result, but it does 
tell us to stop when the end has been attained. 

So a fireman, though he may be ignorant as to the 
quantity of coal which the furnace of his locomotive 
will burn, does not give himself concern on that ac- 
count, for he intrusts the regulation of that matter to 
his infallible manometer. When the desired pressure 
of steam is indicated, he ceases to apply fuel, conscious 



58 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

that he has used only what was indispensable, whether 
much or little has been burned. When it is stated that 
the administration of drugs by the dosimetric method 
can never produce harmful results, it is, of course, pre- 
supposed that the result will be such as would be ex- 
pected from the attentions of a physician who is skill- 
ful and experienced in the use of drugs. If a physician 
has administered an emetic to the point at which it 
produces vomiting, and bad results follow the act of 
vomiting, would it be right to say that the effect of the 
medicament has been harmful ? Assuredly not. The 
fault has been in the method of interpreting the indica- 
tions. 

A medicament which gives exactly the result which 
is expected from it, neither more nor less, is a medica- 
ment which has been accurately administered. Such 
results constitute the great merit and the incomparable 
value of the method of Burggraeve. It is the only one 
by which the caprices of vitality are subjected to the 
intelligent will of a physician. And not only is this 
method exempt from dangers, but it is the only means 
which allopathic practitioners have for avoiding dan- 
gers. It is not difficult to show that, whenever the 
regular practitioners desire to combine efficiency with 
innocuity, the dosimetric method of administration is 
the one which is employed. Xow, as it is impossi- 
ble to correctly understand therapeutics if these two 
conditions are separated — in other words, a remedy 
ought to be always effective, never harmful — one must 
always turn to dosimetry if one desires to make him- 
self truly useful in his medical attendance. In ordinary 
practice, when one wishes that a drug should be effect- 
ive, an attempt is made to render it active by giving it 
in small and repeated doses until the required effect is 
attained, and one should not be satisfied with the com- 
mon method of giving now and then any dose which 
the inspiration of the moment may suggest. If, for 
example, the case be to obtain anaesthesia from the use 



MEDICAMENTS. 59 

of ether or chloroform, to treat a threatening asystole, to 
combat the effects of inanition, to calm a violent pain, 
to dispel a spasm which threatens life — if the question 
be to excite vomiting, or to produce a diaphoretic or 
hypnotic effect — do we not have recourse to the use of 
small doses, which are repeated until the effect is pro- 
duced % Do not our adversaries recognize that there is 
danger from the uncertainty of their doses, from their 
erroneous calculation, in a word, from the absence of 
dosimetry % Has not Fonssagrives said that " the dan- 
gers of mercury are not peculiar to it, but belong to 
all active medicaments, when they are used without 
particular indication, without accurate measurement, 
and without regard for the rules by which they are 
rendered inoffensive "? (" Traite de Therapeutique ap- 
pliquee," vol. ii, p. 190.) Does not Dujardin-Beaumetz 
say : "Heart tonics, like all other medicaments, present 
two distinct aspects : if the dose is carefully measured, 
good therapeutic results will follow ; if it is excessive, 
the scene will change, and a toxic effect will appear " % 
("Lecons de Clinique therapeutique," p. 60.) 

And, on the other hand, when the regular practi- 
tioners do not dare to meet the dangers which they 
believe are found in the dosimetric system, is it gener- 
ally known what plan they follow % Let us see what 
they say upon this point : According to Fonssagrives, 
" the most active alkaloids — digitaline, veratrine, strych- 
nine, even aconitine, the salts of arsenic, etc. — may be 
used as well for the treatment of children as for adults, 
and any therapeutist who would deprive himself of 
their usefulness would be deficient in good judgment. 
Everything depends upon the doses, which should he 
'very small at the beginning, and gradually increased, 
according to the effects observed, so they will yield all 
the desirable probabilities associated with innocuity. 

"Every medicament, however great its activity, is 
applicable to practice among children, not excepting 
those medicaments to the action of which children show 



60 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

the greatest susceptibility ; opium and tartrate of anti- 
mony, for example, need not be absolutely excluded 
from such practice. Everything depends upon the ap- 
propriate indication and graduation of the doses. 

"The principle of administering the antispasmodics 
in minute doses clears away all difficulty, and enables 
us to obtain satisfactory results. 

"Finally, having taken the precaution of beginning 
with the smallest dose (of strychnine), of watching its 
effects, and of increasing or diminishing the fractional 
doses, as circumstances demand, we can feel secure from 
all risk of accidents." ("Traite* de Therapeutique ap- 
pliquee," 1882, pp. 527, 572, 577.) 

The great dangers of dosimetry, therefore, are re- 
duced to this : these are the great crimes of which it is 
accused ; these are the reasons which prevent our ad- 
versaries from adopting our method. This is the retort 
which we give to the accusation against the system, 
viz., dosimetry is effective without ceasing to be inof- 
fensive ; it is inoffensive without ceasing to be effective. 

We are therefore warranted in offering the following 
conclusions : 

1. Therapeutics always aims at a result. 

2. The result can only be obtained by a dose which 
shall be sufficient. 

3. The sufficient dose can not be established in 
advance either by calculation, by experience, or by 
inspiration ; we must give the remedy until the suffi- 
cient result is obtained, without especial regard to the 
quantity taken, but only to the objective and subjective 
modifications which an examination of the patient will 
indicate. Experience and calculation can only aid us 
in establishing the initial or typical dose, the fractional 
part of a complete dose which should serve to initiate 
the medicative action, and which, when repeated with 
suitable frequency, will constitute the sufficient accu- 
mulated dose. The initial dose should never be capable 
of producing any toxic effect, for, if it did, we would 



MEDICAMENTS. 61 

fall into the clangers of the allopathic practitioners, and 
thus the dosimetric system would lose the characteris- 
tics which give to it all its value and all safety. 

CUEATIVE ACTION. 

Since living matter can be modified in its dynamism, 
and in its material constitution, and since substances 
which are foreign to the organization may be the agents 
of this modification, it is easy to understand that the 
mechanism by which morbid phenomena are produced 
is the same as that by which the action of medicaments 
is realized. Both the former and the latter are the result- 
ant of physico-chemical movements struggUng with the 
vital motion. There is no difference between the modi- 
fications which are produced upon the body in its nor- 
mal condition by morbific agents, and those which are 
effected in the pathological condition by therapeutic 
agents, if we consider them in their essence. If there 
are any differences at all, they arise entirely from a 
diversity of causes — a diversity which may result from 
their particular quality, their degree of intensity, the 
duration of their action, or the time at which they are 
produced. 

Pathology has chapters in common with pharma- 
cology and therapeutics. Saturnism, hydrargyrism, 
narcotism, ergotism, or accidents from lightning, are 
morbid conditions which are distinguished from ordi- 
nary medication with lead, mercury, opium, ergot, or 
electricity, only by the degree of intensity or the dura- 
tion of the action of the agent which produces modifica- 
tion of the vital phenomena. 

The laws which govern the two classes of phenomena 
are common and identical ; the results differ with the 
differences in the conditions, which it is impossible not 
to take into consideration in our calculations. 

It should not be a matter of surprise that hygiene 
and therapeutics — the two sciences which teach us as 
to the means which will have a favorable effect upon 



62 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

the organism in health and the organism in disease — 
should really exist as sciences. Indeed, their existence 
conld only be denied by minds which are systematically 
preoccupied in wrong directions, or are totally devoid 
of every faculty of observation. 

But, after having shown that intervention by thera- 
peutic means is possible, it remains for us to determine 
the conditions which shall render them useful and 
effective. It has already been stated in general terms 
how curative action by means of medicaments is accom- 
plished ; but, if we were to descend to particulars, and 
to the particular reaction of each medicament and each 
morbid element, the problem would become insoluble, 
because we are entirely ignorant of the exact means for 
determining phenomena which change the condition of 
health ; neither do we know the cause of the differences 
which exist in the force which is exercised by certain 
substances, among which substances we must include 
medicative agents. The results from the intimate action 
of a remedy can scarcely be ascertained by analysis. 
Only a comparison of these results of the most simple 
action of remedies with the most simple vital perturba- 
tions enable us to conclude that the curative action is 
exercised in opposition to primary or secondary results. 
The old principle, contraria contrariis curantur, is 
still the one which explains the greater number, if not 
all cases. Not that it was a difficult matter to explain 
them by the contrary principle, similia similibus cu- 
rantur, for, as we have already seen, the principle of 
vital equiponderations teaches us that a divergence in 
one sense is always balanced by a divergence in a con- 
trary sense. If there be a congestion in one organ 
which is caused by vascular tension in a neighboring 
organ, if spasm is always accompanied by a compen- 
satory paralysis, if, in a word, life retains its equi- 
librium only by means of antagonisms which are ad- 
mirably adjusted, any displacement whatsoever of force 
or of matter must necessarily result in a want of equi- 



MEDICAMENTS. 63 

librium of antagonistic forces, which can neither be 
limited nor prevented. But the formula of the homoeo- 
paths fails to satisfy according as physiology opens to 
us new horizons and explains pathological phenomena. 
Between the old idea concerning inflammation and that 
which follows from the results of physiological analysis 
— which attributes the primary cause of the phlogosis 
to vaso-motor paralysis — there is so much difference 
that the scientific basis of the reform which was insti- 
tuted by Hahnemann seems likely to fall, and in its fall 
it must include the entire system which was constructed 
by the founder of the homoeopathic doctrine. But, 
instead of dwelling upon these sub til ties, it will be 
more profitable for us to inquire exclusively as to the 
indications which an examination of a sick person pre- 
sents to us, in order that we may relieve the urgent 
necessities of the organism which has been invaded. 
In many cases the analysis of a diseased element will 
enable us to judge as to the proper antagonistic modi- 
fications which we should at once employ in order to 
restore readily and quickly the equilibrium. For ex- 
ample, in a case of dysuria, we will find spasm of the 
neck of the bladder, associated with paralysis of the 
body. The indication will, therefore, be to administer 
an anti- spasmodic — hyosciamine, for example — in order 
to overcome the spasm ; at the same time we should 
use a nerve - stimulant — for example, strychnine — in 
order to overcome the paralysis, and give to the longi- 
tudinal muscular fibers the tonicity in which they are 
deficient, either because it is concentrated in the sphinc- 
ter or has been wasted in repeated contractions. In 
accomplishing this end, should we follow the principle 
contraria contrariis, or the opposite one, similia simili- 
busf 

Apparently both ; but our treatment, though it 
could appear to be contradictory, is, in reality, physio- 
logical, for we seek to overcome the want of equi- 
librium, and to antagonize merely the aberrations of 



64: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

the physiological mode. Therefore, whenever we are 
able to discover the primary, elementary morbid change, 
our efforts to produce a cure must follow the principle 
contraria contr arils. This is the clearest, most nat- 
ural, the most simple, and the most logical method. 
We readily admit that the disease will disappear only 
after another disease has been artificially produced. 
While we admit that all medicative action is only a 
modification of the organo-dynamic condition, and that 
diseases are only the different modalities of matter ani- 
mated by vital dynamism, we find that every cure is 
the result of a morbific action, which is more or less 
intense and more or less fleeting. But it is by no means 
necessary that this artificial disease should correspond 
to the original one either by intensity or by nature ; 
indeed, in most cases, the cure can only be explained 
by the opposition between the modifications effected 
by the remedy, and those which were caused by the 
disease. 

The cures which are accomplished by means of the 
attenuated and infinitesimal doses of homoeopathy, and 
which are attributed by many to medicative force, nat- 
urally lead to the consideration of the worth of this 
force as a curative agent. If this force exists, its effects 
should be most clear and manifest in the simplest cases 
— that is, in those which would tend to recovery with- 
out the intervention of therapeutic means. 

Suppose we take a very simple case of congestion ; 
what has occurred % Blood has accumulated in a ves- 
sel, its pressure has increased, its walls have been dis- 
tended and made thin, and, should the pressure grad- 
ually continue, the elasticity of the vessel will be over- 
come, its force of cohesion will be vitiated, its walls 
will be torn, and the result will be a haemorrhage of 
greater or less volume. As the blood is discharged, the 
pressure is relieved, the walls come together again, the 
congestion disappears, the blood is coagulated at the 
point of rupture, and the haemorrhage ceases, or, on 



MEDICAMENTS. 65 

the other hand, it continues to flow, and the use of a 
haemostatic becomes necessary. Do we not see in this 
process a series of successive modifications in perfect 
relation, and dependent, each upon the other? And 
is it not thus that morbid phenomena are evolved when 
the disease gets more severe and the supposed medica- 
tive force is ineffective? Is there any cause for the 
supposed intervention of any special force differing 
from the forces which result from physical, chemical, 
and vital movements, in order to explain the cessation 
of the congestion? But, if the walls of the vessel in 
the supposed case of congestion do not yield to the 
excess of pressure, how can the medicative force inter- 
fere so as to overcome the cohesion of the walls of the 
vessels? Moreover, if it overcomes this cohesion, it 
must, in destroying one disease, give rise to another, 
which will be longer in duration and more severe ; and, 
should haemorrhage take place in a very sensitive area 
— in the brain, for example — death itself might be 
caused by the use of the agent which had developed a 
great or even fatal lesion out of a slight perturbation 
of the physical forces. 

In order that a force be medicative, it should act 
suitably upon associated morbid phenomena with due 
and clear reference to their cause ; it should foresee and 
calculate the consequences as well as the opportunity 
of its intervention ; it should act with suitable intensity 
upon succeeding phases of the disease for the cure of 
which it is given ; and it should seem to exercise a kind 
of selection as to the means and the place of its appli- 
cation. A force of this character should, of necessity, 
be intelligent, omniscient, and omnipotent — in a word, 
it should be divine. But, if it has these qualities, it 
should also know how to vary the method of treatment, 
as a haemorrhage of the brain is not a haemorrhage of 
the intestines or of the lungs. But observation teaches 
us that there is no intelligence of any character which 
presides over natural crises ; that the force which is at 
5 



6Q ELEMENTS OF THERAPEUTICS AND PRACTICE. 

work is blind, inconsiderate, and absurd ; and that its 
action may be limited to insignificant cases, or that it 
may aggravate cases of the greatest gravity ; we may, 
therefore, conclude that this force has no real existence, 
and that it is folly to rely upon it for the amelioration 
of any disease whatsoever. The notion of a medicative 
force (vis medicatrix naturce) has originated from 
numerous instances in which cure has resulted either 
without the aid of a physician or even in spite of un- 
suitable interference on his part. This is not suffi- 
cient to establish our belief in the existence of any 
force which could be of advantage to the sick. As 
well might we say that there is a medicative force 
in time, for we see the sun succeed the storm ; or 
that there is a force in the earth which preserves it, 
since the convulsions of the globe do not last ; and 
volcanoes become quiet after a period of efferves- 
cence, and after they have vomited up their incandes- 
cent lava. 

The medicative force is therefore a myth — an ex- 
pression which has no meaning, further than that a great 
many cases of disease get well spontaneously. The 
getting well is not effected by means of a particular 
force ; it is the result of a transformation of effects, in 
a curative sense, which is caused by the condition of 
the organs involved, by the external medium, by ali- 
mentation, or by the state of the functions which have 
remained unaffected, or the trouble of which tends nat- 
urally to diminish by itself. 

It is only by reasoning in this way that we can 
understand how a disease which is benignant at its 
outset suddenly becomes dangerous under the influence 
of some agent or other, which prevents an evolution in 
the direction of health, in spite of the illusion of a 
medicative force. Therefore, since this force has no 
real existence, while the force of medicative agents does 
exist, therapeutic intervention becomes an indispensa- 
ble obligation, which is laid upon the physician from 



MEDICAMENTS. 67 

the time when the first abnormal phenomenon appears 
until the patient has ceased to live. 

SYSTEMATIC THERAPEUTICS. 

The treatment of a disease is a warfare, a campaign 
in which the physician studies to find out the strength 
and the tactics of his enemy, the theatre of his opera- 
tions, and the troops at his disposal, before he elabo- 
rates a plan for his own offensive and defensive conduct. 
As soon as he has joined battle, he should not only 
think of victory, but should seek to cut off the retreat 
of the vanquished, follow up fugitives, repress disorder, 
clear away that which has been destroyed, establish 
peace and harmony, arouse prosperity anew, and re- 
store that which has been devastated by war. 

Disease is a very complicated ensemble of phe- 
nomena, which follow each other without interruption, 
from the moment when the cause begins to act, until its 
last effects are terminated either by a return to health 
or by death. Therapeutics constitutes an arsenal of 
arms of various kinds, each one of which may be han- 
dled in a thousand different ways. Between the mo- 
ment when we find ourselves in the presence of a sick 
person, and that in which we are required to draw up 
a plan of treatment, a period of time, usually very 
short, will elapse, in which this plan must be outlined. 

It is, therefore, desirable that we have some method 
which will abbreviate our work as much as possible, 
and habituate us to the detachment of the leading in- 
dications and the choice of the best agents, and which 
will enable us, in a word, to trace the general lines of 
a therapeutic system. 

The classification of diseases has an advantage : it 
is, that the presence of certain symptoms leads us to 
anticipate others, and that their order of succession 
reveals to us the existence of latent perturbations, as 
well as the nature of the causes which have aroused 
them. 



68 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

A particular diagnosis in the various cases of disease 
is a necessity, but, without being limited to the de- 
termination of the locality of the principal morbid con- 
dition, we should also not neglect the ascertaining of 
the nature of the primordial perturbations and their 
original causes. This point is the more important, be- 
cause, if we can settle it in the dynamic or preparatory 
phases of diseases, and then know how to interfere 
effectively, we can cut short the subsequent phases. 
In variola, for example, we can not diagnosticate that 
the disease is localized at any one point ; we merely 
observe fever and other uncertain and temporary symp- 
toms. But, if we are able to recognize the nature of 
the disease and its main cause by destroying the lat- 
ter, we can arrest the natural evolution of the morbid 
processes, and reduce the duration of the disease to a 
very few days ; while, if left to take its course, it would 
reach its end only after the patient had suffered for a 
long time, and had lost much strength. 

If we are called to investigate any morbid condition 
whatsoever, our first thought should be to discover the 
cause of disease. That cause, when discovered, will 
either be still in existence or will have passed away. 
If it still exists, we must fight it with the greatest en- 
ergy, in order to destroy it, to neutralize it, or to pre- 
vent its results. If the original cause has disappeared, 
we can no longer operate upon it, but we can and 
should direct our efforts upon its results. These results 
may be primary, secondary, tertiary, etc., and it will 
be our duty to fight them in the order in which they 
were developed, choosing for particular attention, 
among those which appeared at the same period, the 
ones which are the most grave, the most perturbant, 
and the most insupportable. 

The medicaments which are directed toward the 
principal element, which is the origin of all the other 
morbid elements, constitute what is called the domi- 
nant, whether that element be a pathogenic cause or 



MEDIOAMENTS. C9 

only the cause of a group of secondary symptoms. 
When these primary perturbations are cured, it some- 
times happens that some of their effects remain. The 
dominant will vary, in that case, according as different 
morbid elements preponderate. The symptoms which 
have arisen from a principal morbid element, which can 
not disappear rapidly, may give rise to suffering, and 
act unfavorably upon the course of the disease by giv- 
ing rise to new series of symptoms, or by perverting 
the action of the medicaments, or by increasing the 
primary want of equilibrium. 

These symptoms must be antagonized, whatever be 
their hierarchical position. Remedies which are occu- 
pied with this function constitute what is called the 
variant. Therapeutics has only diseases to fight, and, 
as diseases are always accompanied by changes in the 
vital phenomena, we can not introduce into therapeu- 
tics, nor call by the name of medicaments, the neutral- 
izing chemical bodies which are intended to prevent 
the sad results which attend the action of poisonous 
substances. Before the absorption of the poison, or 
before its action upon the surface of the organs, no 
vital modification is possible, no disease has been pro- 
duced. The antidote acts as it would act in a beaker 
in the laboratory ; its effects are purely physical or 
chemical, and, indeed, there is no medicative action 
without the intervention of vitality. It is only after the 
poison has acted upon the tissues or the functions that 
disease actually exists, and therapeutics can interfere. 
The confusion between chemistry and therapeutics 
originated in the classical languages, and has been 
retained by pious tradition. The intervention which 
follows the ingestion of a poison, and which is certainly 
indispensable to prevent the results which would other- 
wise follow, certainly belongs to the domain of medi- 
cine, but it belongs rather to the department of hygiene 
than to therapeutics. The latter is limited in its func- 
tion to curing ; it neither encroaches upon physics nor 



70 ELEMENTS OF THERAPEUTICS AND PEAGTICE. 

upon chemistry, excepting in those cases in which it 
is preventive. It is self-evident, however, that a phy- 
sician can not fail to be interested in the action of anti- 
dotes, in order that he may ward off the action of poi- 
sons upon the organism in every way. What has been 
said about antidotes is equally true about certain medi- 
cations which have for their sole object the modification 
of fermentations, the absorption of gases, and the elimi- 
nation of foreign bodies. It is indispensable that the 
causes of disease disappear if we are to effect a cure ; 
but true curative therapeutics is concerned with the 
results of causes, and not with the causes themselves. 
That is why the physician must bring to bear precise 
and rapid agents for the destruction or the elimination 
of the cause. He will choose these means from chemi- 
cal and physical agents, parasiticides, and eliminators, 
limiting his action to the nature of the cause, to the 
means at his control, and to the tolerance of his pa- 
tients, whose organism should remain at least neutral 
upon its own territory in this struggle, which is carried 
on in its behalf. 

It is only after one has been attacked and injured 
that he has a right to demand the services of a physi- 
cian, who will come to his aid, and will serve, as he 
ought, as an ally of Nature. When the organism 
passes from the defensive to the offensive, with its con- 
sequences, the time has arrived for putting the thera- 
peutic system into operation. 

This system will have for its objective point the pre- 
vention of the prolongation and multiplication of the 
existing troubles which engender others. We shall be 
able to control the latter the more easily by strangling 
the rebellion in its incipient state as rapidly as possible. 
The jugulation of diseases is one of the most important 
duties which are imposed upon the physician. In order 
to accomplish it he must lose no time, but begin the 
struggle forthwith. In the dynamic stage of diseases, 
jugulation (cutting off, as by strangling) is relatively 



MEDICAMENTS. 71 

easy ; in the preparatory stage there is more difficulty, 
and it is sometimes insurmountable when the disease 
is completely under way. In that period we may be 
able to prevent the progressive evolution of the disease, 
but it will be impossible for us to repair, in a few 
hours, the injuries of substance which have been ef- 
fected ; for, while it is possible to correct in an instant 
disturbances of motion, modifications of substance al- 
ways require time for their accomplishment. Accord- 
ing as the nature of an injury is dynamic or material 
shall we conclude as to the activity of the medication 
which is required. The rule is as follows : For every 
acute disease, acute treatment ; for every chronic dis- 
ease, chronic treatment. But, in order to establish this 
acuity or this chronicity, it is not the progress of the 
disease in its ensemble which must be considered, but 
rather the rapidity with which the morbid elements are 
established which are to be antagonized. An hysterical 
paralysis may be chronic ; it may have lasted several 
months or even years, and yet require acute treatment, 
because, as it was established quickly, it may also dis- 
appear quickly, perhaps in a moment, or even from the 
influence of a moral impression. But, if this is to be 
accomplished, there must be no appreciable modifica- 
tions of tissue, for the cure of such conditions is a mat- 
ter of nutrition, and all the means at our disposal for 
the modification of nutrition are feeble, slow in their 
action, and not precise. In a word, the plan of treat- 
ment should be more acute, as the morbid element 
which it aims to correct is more essentially dynamic ; 
and the more chronic, as the dynamic perturbations 
have been transformed into lesions of substance. The 
best rule will be to investigate the nature of the princi- 
pal morbid elements and their filiation or succession 
in the primary perturbations. For example, paralysis 
which results from cerebral haemorrhage always comes 
on suddenly, without presenting any indication for the 
acute plan of treatment for paralysis. 



72 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

This element is, in effect, already secondary ; the in- 
dication is to combat the primordial dynamic lesion — 
that is to say, the vascular atony — which has allowed 
the haemorrhage to take place. It will also be necessary 
to administer ergo tine in the most acute manner possi- 
ble, because this medicament, by increasing the con- 
tractibility, causes the haemorrhage to cease, and pre- 
vents its recurrence. The necessity for acute medication 
being granted, it still remains to estimate its degree of 
acuity. In this respect we should be governed by cir- 
cumstances. We aim at obtaining as rapid an effect 
as possible, in so far as therapeutic action can be ac- 
complished without harm to the patient. Herein lies 
the question of dosage and of graduated effects, upon 
which it is useless to insist. The dose is determined, 
in general, by the quantity of the medicament which 
is contained in each granule — a quantity which may 
serve for the average in most cases. However, the most 
active alkaloids — like strychnine, morphine, hyoscia- 
mine, atropine, daturine, colchicine, etc. — should be 
given in fractions of granules when the administration 
of the first granule gives evidence of an excessive im- 
pressionability on the part of the patient, or when his 
age leads one to fear intolerance of the medicament 
after the first few doses have been given. 

It is often necessary, however, to double or treble 
the fractions of doses in order to produce an effect ; that 
is, to give two, three, or even more granules at once 
when we wish to lengthen the intervals, to bring on the 
effects more rapidly, to overcome some apathy to the 
action of drugs, or any morbid resistance of an excep- 
tional character. In the chronic diseases, which call 
for a plan of chronic treatment, we can proceed in two 
ways : we can either give the same dose on each occa- 
sion, increasing it at long intervals, and relying upon 
time and the persistence of slight effects to obtain the 
desired result, or we can increase the quantity of the 
drug at each dose until a perceptible effect is obtained. 



MEDICAMENTS. 73 

Suppose we take for an example an atonic condition 
of the stomach, for which strychnine is indicated. We 
will administer one or two granules before each meal 
for a long time. In some cases no effect will appear, 
the dose being insufficient ; in others, these small doses 
will go on accumulating until their useful effect is ap- 
parent, and then the effects of the drug will remain 
concealed, while the curative effects will be the only 
ones which are evident. 

But, in place of administering this constant dose of 
strychnine, we may give one granule on the first day, 
two on the second, then three, four, five, six, or more 
at a time, until the curative effect is obtained, or an 
important physiological one. 

This latter method of administration is especially 
fitting in the chronic organo-dynamic diseases ; the for- 
mer in those chronic diseases in which the organic le- 
sions constitute almost entirely the disease, while the 
dynamic troubles are of very little account. 

The variability of individual impressionability, 
which may change from one day to another, renders 
the latter method of administration the less safe, and 
limits its use to those cases in which the indications 
are very clear, and in which medication is addressed 
to a morbid element of great genealogical importance. 
This plan of treatment can not be continued for a very 
long time, but, as the doses are increased very grad- 
ually, the dangers of a result which was not anticipated 
are not great. 

After the effect has been obtained, we should con- 
tinue the use of the same agent, but in gradually de- 
creasing doses. It should be understood that dosime- 
try, the principle of which is that there is no sufficient 
effect without a sufficient dose, supplies all the means 
for testing the impressionability, so as to be able to 
accomplish much with safety in a small period of time. 
When the disease reaches its stage of reparation, the 
physician must still interfere, but rather to furnish that 



74 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

which the organism lacks than to modify it. It is a 
kind of expectation of a protective character, which, 
while allowing Nature to pursue her course, and trans- 
form morbid results into healthful processes, furnishes 
her in an intelligent manner with a liberal supply of 
the substances which are necessary for organic repair, 
such as iron, arsenic, phosphorus, and lime, which are 
complementary to alimentation, and, by means of the 
dynamophores (caffeine, guaranine, brucine, strychnine), 
increases the sum of vital energy, which is necessary 
for the complete repair of the tissues and forces. What 
we are about to say in our "Elements of Clinical Thera- 
peutics," and what has been already expressed in other 
works on dosimetric medicine, will give the physician 
the instruction and the confidence which he requires to 
treat the different varieties of disease. The pharmaco- 
logical memorial and the list of the principal morbid 
elements, and the most useful medicaments which are 
appropriate for them, will greatly facilitate the arduous 
task of elaborating a therapeutical system which shall 
answer the principal necessities of the sick. 



PHARMACOLOGICAL MEMORIAL 

OF THE DRUGS WHICH ARE IN USE IN 
DOSIMETRIC MEDICINE, 

WITH A STATEMENT AS TO 

THEIR DOSES, THEIR PRINCIPAL PROPERTIES, 

AND THEIR MODE OF USE. 



PHARMACOLOGICAL MEMORIAL. 



Acid, Arsenious. — In granules of one milligramme 
each. This drug acts as a restorer of the nutrition, and 
has a great influence upon the blood- and heat-produc- 
ing functions. It is indicated in chloro- anaemia, leu- 
corrhcea, the ataxo-adynamic fevers, cholera, purulent 
cachexias, in certain cutaneous affections, such as ele- 
phantiasis, psoriasis, icthyosis, etc. It is a febrifuge, 
and may be used as a succedaneum or an auxiliary to 
quinine in the treatment of malarial fever. In acute 
conditions, one granule every half -hour or hour may 
be given, according to the intensity of the disease, until 
an effect is produced ; in chronic conditions, from ten 
to twenty daily may be used. 

Acid, Benzoic. — In granules of one milligramme 
each. This is the immediate principle which is found 
in all the balsams. When introduced into the organ- 
ism, it transforms uric into hippuric acid, which, when 
combined with the ordinary bases of organic fluids, 
forms soluble salts. It is indicated in gravel, gout, etc. 
It also has stimulating properties, and favors expectora- 
tion ; but, as it is only slightly soluble, it is better to 
administer it in the form of salts — for example, benzo- 
ate of ammonia, soda, or lithia. 

It is often used in the subacute and chronic forms 
of bronchitis among children, and is also suitable for 
cases of laryngeal catarrh with hoarseness. Dose, two 
granules every hour, or three granules three or four 
times a day. 



78 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Acid, Phosphoric. — In granules of one milli- 
gramme. It is an hsemogenic excitant, which is used, 
with strychnine, in the first period of inflammations, in 
all algid affections, and in depraved conditions of the 
nervous system. Phosphoric acid has been used suc- 
cessfully in the scrofulous disorders of children. Dose, 
eight to twenty granules a day. 

Acid, Salicylic. — In granules containing one cen- 
tigramme. It is antiputrescent, antiseptic, and anti- 
febrile. It is indicated in all zymotic diseases, espe- 
cially in diphtheria, malaria, eruptive fevers, etc. It 
is also appropriate in different forms of dyspepsia, 
especially those in which there are fetid eructations. 
Dose, one to three granules at a time, at shorter or 
longer intervals, according to the case. It is also use- 
ful as a topical application in all forms of epithelial 
degenerations. 

Acid, Tannic {Tannin). — In granules containing 
one centigramme. Indicated, on account of its astrin- 
gent properties, in all conditions in which there is 
marked relaxation of the tissues. It is useful for haem- 
orrhage, and for discharges of a mucous character, for 
the atonic diarrhoeas of children, and as a topical appli- 
cation (chewing the granules) for chronic forms of gin- 
givitis, amygdalitis, and pharyngitis, or, dissolved in 
water, for subacute forms of conjunctivitis. Dose, two 
or three granules three to five times daily. It should 
never be given with the alkaloids, nor with the greater 
number of the metallic salts, since it forms insoluble 
compounds with them. 

Aconitine. — In granules of one half of a milli- 
gramme. This is a valuable anti-congestive, and the 
best of the antiphlogistics. It is indicated for all 
febrile and inflammatory conditions to moderate the 
fever and reduce vascular tension. It is useful in all 
gastro-intestinal irritations, and in those of the respira- 
tory apparatus. It possesses decided cholagogic prop- 
erties, and is a diuretic and sudorific. It should be 



PHARMACOLOGICAL MEMORIAL. 79 

associated with digitaline and veratrine in intense feb- 
rile conditions, and with strychnine when there is a 
depressed condition of vitality. 

Dose, in the acnte state, one granule every fifteen 
minutes or every half-hour, or larger doses may be 
given if the case demands it. In the chronic condition 
two granules may be given three or four times a day. 
The thermometer should always serve as a guide in the 
use of aconitine. 

Agaricine. — The active principle of agaric. The 
granules contain one milligramme each. It is an excel- 
lent active succedaneum with atropine in the treatment 
of nocturnal sweating. 

The dose is three to six granules daily. 

Anemonine. — The volatile, crystallizable principle 
which is obtained from the anemone Pulsatilla. Each 
granule contains one milligramme. This alkaloid is a 
decided irritant, and has a physiological action analo- 
gous to that of aconitine, but with this difference — that 
it stimulates the nervous centers. It may be used in 
paralysis, whooping-cough, and constipation. It is a 
medicament which is not very well known, but is capa- 
ble of giving excellent results. The dose is two gran- 
ules three to five times daily. 

Apomorphine. — In granules of one milligramme. 
It is a useful expectorant in cases of bronchitis and 
pneumonia in children. It is a tonic to the respiratory 
apparatus, and for this reason is indicated in capillary 
bronchitis in connection with brucine. When used 
hypodermatically in doses of one centigramme, it acts 
as an emetic. The dose is one to two granules every 
hour, or more may be given if necessary. 

Arbutine. — A glucoside, in granules containing one 
milligramme, which is obtained from the arbutus. It 
is to be given in doses of two to three granules, three 
or five times daily, in chronic affections of the bladder 
and urethra. It is also given to increase the flow of 
urine. 



80 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

In rebellious cases of bronchitis in lymphatic indi- 
viduals, arbutine is also indicated. 

Arseniate of Antimony.— In granules of one mil- 
ligramme. It modifies the vitality and the nutrition 
of the organs which are innervated by the pneumo- 
gastric nerve. Used as an expectorant, it has the dis- 
advantage of diminishing the appetite. 

The dose is one to two granules every two hours. 
It is also used to modify disordered conditions of the 
heart, in doses of one to six granules daily. 

Arseniate of Caffeine. — In granules of one milli- 
gramme. It is indicated in the condition of cerebral 
torpor which attends infectious diseases, and in cases 
in which the energy of the heart is weakened. In peri- 
odical cephalalgia and hepatic congestions of malarial 
origin, its prolonged use is beneficial. Two granules 
may be given every two hours. 

Arseniate of Iron. — In granules of one milli- 
gramme. It is the best regenerator of the blood in 
chloro-ansemia, in conditions of convalescence, and in 
haemophilia. It is also useful in the dermatoses of 
lymphatic persons, and in leucorrhcea. Dose, six to 
twelve granules daily. 

Arseniate of Manganese. — In granules of one 
milligramme. It is used in the same doses and for the 
same purposes as the similar salt of iron, when the lat- 
ter can not be tolerated. 

Arseniate of Potash.— In granules of one milli- 
gramme. Dose, six to ten granules daily. To be used 
for various affections of the skin, digestive disorders, 
and liver troubles. 

Arseniate of Quinine. — In granules containing 
one milligramme each. It is used in doses of six to 
twenty granules daily to counteract the element of 
periodicity which is present as a complication in certain 
diseases. It is also useful in affections of the skin which 
have evening exacerbations, and for lesions of the liver 
and spleen which are the result of malarial poisoning. 



PHARMACOLOGICAL MEMORIAL. 81 

Arseniate of Soda. — In granules of one milli- 
gramme each. An agent which modifies the nutrition 
in general, and that of epithelial tissues in particular. 
It is useful in diseases of an herpetic character, and in 
all the chronic engorgements. When associated with 
iodoform, it modifies the work of suppuration. Dose, 
six to twelve granules daily. 

Arseniate of Strychnine. — In granules contain- 
ing one half a milligramme each. This is the neuro- 
sthenic par excellence, and the best vital incitant. It 
may be used with profit in almost all diseases, but 
especially in those which are accompanied with paraly- 
sis or atony. It should be administered in the initial 
stage of all pyrexias, to antagonize vaso-motor paraly- 
sis, and should be associated with phosphoric acid. In 
cases in which defer vescents are badly tolerated, a com- 
bination of them with strychnine will enable us to use 
them until their effect is produced. In the spasmodic 
affections, it assists in establishing the physiological 
equilibrium by combating the paralysis, while hyoscia- 
mine attacks the spasm. 

It is a tonic for all the apparatuses and for all the 
functions, and one of the principal means for produc- 
ing longevity. 

Dose, one to two granules, at intervals which must 
be governed by the acuteness of the disease and the 
degree of diminution of the vitality. 

Asparagine. — In granules containing one milli- 
gramme each. It is the active principle of asparagus. 
It has a feeble diuretic action, and is calmative to the 
urinary passages. It is useful in the first stage of 
urethritis and cystitis. Dose, ten to twenty granules, 
repeated several times. 

Atropine. — In granules containing one half a milli- 
gramme each. An alkaloid which is obtained from 
belladonna. Its principal action consists in contractil- 
ity and in diminishing secretions. It may be employed 
in all conditions of spasm, and for that reason it is 



82 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

useful in tetanus, hydrophobia, photophobia, internal 
strangulations, gastralgia, and the neuroses, such as 
hysteria, chorea, and epilepsy. It is also given to 
facilitate parturition, because it dilates the neck of 
the womb and regulates its contractions. It is useful 
for ptyalism, nocturnal sweating, and incontinence of 
urine. Dose, one granule every half -hour, in very acute 
cases ; in others, one granule every hour, every two 
hours, or less frequently, according to the condition 
of the disease or the tolerance of the patient. Atropine 
is borne by children better, relatively speaking, than 
by adults. 

Benzoate of Ammonia. — In granules of one centi- 
gramme each. It is a mild stimulant to the catarrhal, 
urinary, and sudoral secretions. It is very useful in 
apyretic forms of bronchitis in children, to facilitate 
and then to diminish expectoration ; also, in atonic 
forms of cystitis. Dose, ten to twenty granules daily. 

Benzoate of Lithine. — In granules containing one 
centigramme. It is indicated in all the lithiases and 
gouty troubles, and also in affections of the urinary 
passages. Likewise is it useful in pyrosis, and dys- 
pepsia from excessive secretion of acid. Dose, ten to 
twenty granules daily. 

Benzoate of Soda. — In granules containing one 
centigramme. Its indications and doses are the same 
as those of the two preceding salts. 

Biniodide of Mercury. — In granules containing 
one milligramme. It is to be used in the same cases 
in which the protoiodide of mercury is indicated, for 
all the phenomena which are connected with the syphi- 
litic diathesis. Dose, three to twelve granules daily. 

Brucine. — A very bitter alkaloid obtained from 
nux vomica and false angostura. Each granule con- 
tains one half a milligramme. It has properties analo-* 
gous to those of strychnine, but without the intensity 
of the latter. It is usually substituted for strychnine 
in the treatment of disease in children, and is useful 



PHARMACOLOGICAL MEMORIAL. 83 

and almost indispensable in capillary bronchitis, in 
paralysis, and in atonic forms of dyspepsia. It has 
also been used in rachitis, and, in general, in all the 
affections in which the vitality is lowered or threatened. 
Dose, one to two grannies every half -hour, in acute 
cases ; six to twenty granules a day in chronic cases. 

Bryonine. — In granules containing one milli- 
gramme. It is regarded as a tonic to the large intes- 
tine and the respiratory apparatus. It is useful in 
typhoid fever, in pneumo- typhus, in constipation, and 
in recto- vesical paralyses. Dose, one to two granules 
every two hours, in the acute stage ; six to ten daily 
in the chronic stage. 

Caffeine. — An alkaloid, which is one of the dyna- 
mophores, and is derived from coffee. The granules 
contain one milligramme each. It excites the cerebral 
functions and dissipates congestive and comatose con- 
ditions. It is a heart tonic, and, as a result of such 
action, increases diuresis. It is useful in the various 
forms of neuralgia, in vertigo, and in asystolia. Dose, 
in the acute conditions, one or two granules every half- 
hour ; in the chronic, six to twenty daily. 

Calomel (Protochloride of Mercury). — In granules 
containing one milligramme each. It is generally 
given as a vermifuge, six to twenty granules being 
given at once. It is also used as a cholagogue, and 
with advantage in icterus, dysentery, etc. Dose, one 
to two granules every hour. 

Carbonate of Lithia. — In granules containing one 
centigramme. It dissolves uric acid, and is therefore 
useful in all forms of lithiasis. Dose, from six to 
twenty granules daily. 

Cicutine. — In granules containing one half a milli- 
gramme. It is a calmative to sensory and motor de- 
rangements, and a moderator of reflex excitability. It 
is indicated in the diseases of the cord, in many forms 
of neuralgia, in conditions in which there are lancinat- 
ing pains, in insomnia and in neuropathic excitement. 



84: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Dose, in acute cases, one granule every half -hour, until 
the effect is produced ; in chronic cases, six to ten 
granules daily. 

Citrate of Caffeine. — In granules containing one 
milligramme. It is weaker than caffeine, and is ap- 
plicable for the same conditions. 

Cocaine. — In granules containing one half a milli- 
gramme. This alkaloid is a dynamophore obtained 
from ErytJiroxylon coca. It devascularizes and anaes- 
thetizes those tissues with which it is brought in con- 
tact. It relieves congestion of the brain, and preserves 
the nutritive forces. It is very useful when dissolved 
upon the tongue in relieving inflammations of the 
mouth, tonsils, and pharynx. For these conditions it 
should be given in doses of from two to three granules 
every hour or every two or three hoars. In gastralgia, 
oesophagismus, etc., one or two granules may be given 
every quarter of an hour until the desired effect is 
obtained. 

Codeine. — In granules containing one milligramme. 
As a calmative it is weaker but safer than morphine. 
It is used at the beginning of cases of bronchitis, laryn- 
gitis, and tracheitis, combined with iodoform. It may 
also be given in enteritis, enteralgia, in dentition, etc. 
Dose, one to three granules every quarter of an hour, 
or less frequently if necessary. 

Colchicine. — In granules containing one half a 
milligramme. It is diuretic, analgesic, and cholagogue. 
It has emetic or purgative properties which never fail, 
if its use is sufficiently prolonged. It is the drug par 
excellence for the treatment of rheumatism and gout. 
Dose, one or two granules every half-hour, in acute 
cases, until the physiological effect has been produced ; 
six to ten granules daily in chronic cases. 

Colocynthine. — In granules containing one half a 
milligramme. It is tonic and stimulant to gastro- 
intestinal contractility. It is useful in cases of atonic 
dyspepsia, in intestinal torpor, and in habitual consti- 



PHARMACOLOGICAL MEMORIAL. 85 

pation. It is also useful as a vermifuge. Dose, three 
to five granules two to three times daily. 

Cotoine. — A principle which is obtained from the 
bark of coto, a plant which is a native of Bolivia. The 
granules contain one milligramme. This alkaloid has 
antifermentative and antipyretic qualities. It is prob- 
ably analogous to guaranine, and gives excellent results 
in different affections of the digestive apparatus. It 
can be tried to relieve vomiting, dysentery, loss of ap- 
petite, etc. Dose, three granules three to five times daily. 

Croton Chloral. — In granules containing one centi- 
gramme. It soothes hyperesthesia and reflex excita- 
bility. It is indicated in myelitis, nervous cough, 
neuralgia, etc. Dose, two granules every half-hour 
until the effect is obtained. 

Cnbebine. — In granules containing one milli- 
gramme. It is eliminated by the mucous membranes, 
and is therefore useful in cystitis, blennorrhagia, bron- 
chitis, etc. Owing to its stimulant properties, it is also 
applicable in anorexia and apyretic conditions of gas- 
tric disorders. The dose is three to five granules three 
to ten times daily. 

Cyanide of Zinc. — In granules containing one 
milligramme. This salt soothes and settles disturbed 
conditions of the nervous system. It is useful in gas- 
tralgia, epilepsy, etc. It is also advised for affections 
of a rheumatic character. Dose, six to twelve granules 
daily. 

Cyclamine. — In granules containing one milli- 
gramme. It is laxative and cholagogue, but its exact 
properties and indications are not yet well defined. 
The dose is six to ten granules daily. 

Daturineo— In granules containing one half a milli- 
gramme. Its action is calmative and antispasmodic, 
analogous to but more energetic than atropine and 
hyoscyamine. It is sometimes substituted in ophthal- 
mic practice for atropine, being used in solution by 
instillation. It is of service in photophobia and ocular 



86 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

neuralgia, in asthma, nterine colic, etc. [Dose not 
stated.— Teans.] 

Diastase. — In grannies containing one centi- 
gramme. It serves to replace pty aline in buccal and 
intestinal forms of dyspepsia. The dose is one to Hve 
granules with each meal. 

Digitaline. — In granules containing one milli- 
gramme. This alkaloid has a particular action upon 
the heart, increasing its contractility by a moderat- 
ing and regulating influence, and producing a tonic 
effect. It diminishes the number of pulsations when 
they are exaggerated, increases the number when the 
systole is incomplete, and equalizes the pulsations 
when their rhythm is disturbed. It is used for cardiac 
excitement, for all febrile and congestive diseases, and 
for the chronic affections of the heart. It may be used 
daily to regulate the cardiac forces and to contribute 
to longevity. Dose, in acute conditions, one granule 
every half- hour, or less frequently, as the case requires ; 
in chronic conditions, two to four granules daily may 
be given. 

Elaterine. — In granules containing one milli- 
gramme. It is obtained from elaterium, and possesses 
drastic and emmenagogue properties. It may be used 
for the treatment of constipation and hemorrhoidal 
or catamenial suppression. Dose, one to three gran- 
ules two or three times daily. 

Emetic. — In granules containing one centigramme. 
An emetic, purgative, contra-stimulant, and expecto- 
rant, according to the size and frequency of the doses. 
It is used in bronchitis, dyspepsia, pneumonia, and as 
a modifier of cardiac nutrition. Dose, for emetic pur- 
poses, two granules in water, every ten minutes, until 
the desired effect is obtained ; as a purgative, one 
granule every half -hour until the effect is produced ; 
as an expectorant, one granule every two hours. 

Emetine. — In granules containing one milli- 
gramme. An emetic suitable for children, an expec- 



PHARMA COL GIGAL 'MEMORIAL. 87 

torant, contra-stimulant, and antispasmodic. It is 
useful in bronchitis, pneumonia, whooping-cough, dys- 
entery, etc. Dose, as an emetic, two to three granules 
every ten minutes, dissolved in a teaspoonful of water ; 
as an expectorant and antispasmodic, one granule every 
two or three hours. 

Ergotine. — In granules containing one centi- 
gramme. It is used as an excito-motor to smooth 
muscular fibers, in haemorrhages, atony, and inertia of 
the uterus. It is also useful in adynamia and in atonic 
affections of the respiratory apparatus. Dose, three 
to five granules every quarter of an hour, as a haemo- 
static ; two granules every two hours to excite muscu- 
lar action. 

Euonymine. — In granules containing one milli- 
gramme. A tonic to the digestive apparatus and a 
cholagogue. It is useful in hepatic disorders, icterus, 
and dyspepsia. Dose, three to ten granules two or 
three times daily. 

Gelseinine. — In granules containing one half a 
milligramme. It is antispasmodic and antineuralgic. 
It is used in odontalgia, sciatica, for intercostal pains, 
and, in general, for all pain which is more tenacious 
than severe. Dose, one granule every quarter of an 
hour, until the desired effect is obtained. 

Gregory's Salt.— In granules containing one milli- 
gramme. It is a double chloride of morphine and 
strychnine. Its action is calmative, hypnotic, and 
anodyne. It may be used for insomnia, simple coughs, 
abdominal pains, diarrhoea, etc. Dose, one to three 
granules every quarter of an hour, until the effect has 
been obtained. 

G-uaranine, — In granules containing one milli- 
gramme. It is a dynamophore which is obtained from 
Paullinia sorMlis. It increases vitality, and is useful 
in all forms of adynamia. It is also useful for neural- 
gia and migraine. Dose, three granules, three to five 
times daily. 



88 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Helenine. — In granules containing one centi- 
gramme. A crystallizable principle which is analo- 
gous to camphor, and is obtained from Inula Helenium. 
It is antiseptic, antispasmodic, and stimulant to ca- 
tarrhal secretions. It is useful in atonic and putrid 
forms of dyspepsia, in flatulence, in hysterical condi- 
tions, and in catarrhal troubles of the bronchi, larynx, 
and bladder. It may also be used with advantage in 
whooping-cough, phthisis, and blennorrhagia in its final 
stage. Dose, one to three granules three to five times 
daily. 

Hydrastine. — In granules containing one milli- 
gramme. It is a cholagogue, and a tonic to the digest- 
ive apparatus. It is very effective in cases in which 
there is suppression of the biliary excretion and secre- 
tion, and equally so in treatment which is directed 
against the carcinomatous diathesis. Dose, ten to 
twenty granules daily. 

Hydriodate of Morphine. — In granules contain- 
ing one milligramme. Its properties are those which 
are common to the other salts of morphine, but it is 
especially indicated in cough which arises from irrita- 
tion of the bronchi, in laryngitis of rheumatic origin, 
and for osteocopic pains. The dose is one or two 
granules every quarter of an hour until the effect is 
obtained. 

Hydrobromate of Cicutine. — In granules con- 
taining one milligramme. It is a calmative for nerv- 
ous, vascular, or muscular excitement. It is without 
some of the inconveniences of morphine, but has not 
the force of the latter as an antagonist to pain. It is 
useful in nervous irritability of all kinds, in cough, 
in meningo-myelitis, in cystalgia, myalgia, etc. Dose, 
one to two granules every quarter of an hour, in acute 
conditions, until the effect is produced ; and six to 
twenty granules a day in chronic conditions. 

Hydrobromate of Quinine. — In granules con- 
taining one milligramme. It is indicated in cases in 






PHARMACOLOGICAL MEMORIAL. 89 

which, the element of pain is associated with that of 
spasm. Dose, ten to twenty grannies, or more, once or 
more frequently, according to the course of the attack. 

Hydro chlorate of Morphine. — In granules con- 
taining one milligramme. It is narcotic and anodyne, 
and is indicated in all forms of neuralgia and nervous 
irritation ; also at the beginning of all forms of inflam- 
mation, being usually associated with hyoscyamine, 
because pain rarely fails to provoke spasm. It is use- 
ful in catarrhal affections, and in all exaggerated con- 
ditions of sensibility. Dose, one to two granules every 
quarter of an hour until the effect is produced. 

Hydroferrocyanate of Quinine. — In granules 
containing one milligramme. This salt is antiperiodic 
like all the salts of quinine ; but has, in addition, a 
particular calmative action which it owes to the hydro- 
cyanic acid, and tonic properties which it owes to the 
iron in its constitution. It is useful in all diseases in 
which exacerbations occur, and also during the remit- 
tent period of all the pyrexias. 

Hyoscyamine. — The alkaloid of hyoscyamus. In 
granules containing one half a milligramme. It is anti- 
spasmodic, calmative, and analgesic. It is useful in 
all nervous affections in which there is excessive con- 
tractility. It gives good results in constipation, stran- 
gulated hernia, intestinal occlusion, enteralgia, gastral- 
gia, photophobia, dysuria, etc. It diminishes the secre- 
tions of the mucous and sweat glands, and for that 
reason is useful in bronchitis, bronchorrhcea, ptyalism, 
tuberculosis, etc. Dose, one granule every half-hour 
until the desired result is obtained ; or, one granule 
three to five times daily, according to the severity of 
the case. 

Hypophosphite of Lime. — In granules contain- 
ing one centigramme. It is a means of alimentation 
for the bony and nervous systems. In rachitis and 
all affections in which vitality is lowered, and in cases 
in which the hypophosphite of strychnine is too ener- 



90 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

getic a stimulant, this salt is indicated. The dose is 
ten to twenty granules daily. 

Hypopliosphite of Sodium. — In granules con- 
taining one centigramme. The doses and indications 
are the same as the foregoing. 

Hypopliosphite of Strychnine. — In granules 
containing one half a milligramme. It is a tonic and 
stimulant to the nervous system, improving its func- 
tional action and nutrition. It is useful in all cases of 
vital depression caused by overwork, age, or disease. 
It is indispensable in pneumonia in the aged, in all 
adynamic affections, in rachitis, chloro-ansemia, and 
in the prostration which accompanies convalescence 
from severe diseases. Dose, six to forty granules daily. 

Iodoform. — In granules containing one milli- 
gramme. It is a disinfectant with a calmative action, 
and a modifier of nutrition, especially with reference 
to the lymphatic system. It is useful in bronchitis, 
pulmonary gangrene, offensive breath, the lymphatic 
diathesis, and syphilis. It is also useful for the pain 
and congestion which accompany rheumatism. Dose, 
one to three granules every half -hour, for acute condi- 
tions ; three to five granules from three to live times 
daily in chronic conditions. 

Iridine. — In granules containing one milligramme. 
It is a cholagogue and exciter of intestinal con- 
tractility. It is useful in cases in which there is 
suppression of the biliary excretion, in icterus, and 
in hepatic cirrhosis ; diuretic effects have also been 
ascribed to it. Dose, two granules five to ten times 
daily. 

Jalapine. — In granules containing one milli- 
gramme. Its action is tonic upon the small intestine. 
In small doses its action as a purgative is uncertain ; 
in large doses it is a drastic cathartic. Dose, six to 
twenty granules daily. 

Juglandine. — In granules containing one milli- 
gramme. Vermifuge, depurative, and antisyphilitic 



PHARMACOLOGICAL MEMORIAL. 91 

action has been attributed to this drug. It has been 
used with success for scrofula and weaknesses in which 
the torpid element predominates. Dose, six to twelve 
granules daily. 

Eermes Mineral. — In granules containing one 
centigramme. This drug has a modifying influence 
upon the respiratory apparatus and the cardiac nutri- 
tion. It is useful as an expectorant, and also in chronic 
diseases of the heart in the hypertrophic stage. Dose, 
six to twenty granules daily. 

Kousseine. — In granules containing one milli- 
gramme. A vermifuge, particularly for children. 
Dose, one to five tubes in the course of an hour. 

.Lactate of Iron. — In granules containing one 
centigramme. An iron salt, which is usually well 
tolerated, even by those who have stomachs which are 
sensitive to the astringent action of iron. It may be 
used in chlorosis, anaemia, atonic diarrhoeas, etc. Dose, 
three to ten granules daily. 

Leptandrine. — In granules containing one milli- 
gramme. It is cholagogue and tonic to the organs of 
the digestive apparatus. It is useful in the hepatic 
diseases, in enteritis, in choleriform diarrhoea, etc. 
Dose, six to twenty granules daily. 

Lobeline. — In granules containing one half a milli- 
gramme. It is expectorant and antispasmodic, is use- 
ful in acute and chronic affections of the respiratory 
apparatus, especially in those of children. Dose, four 
to twelve granules daily. 

Lycopine. — In granules containing one milli- 
gramme. A narcotic and astringent action has been 
attributed to it, which would make it useful in cases 
of convulsive cough and other pulmonary affections. 
Dose, six to ten granules daily. 

Monobroniate of Camphor {Bromide of Cam- 
phor). — In granules containing one centigramme. It 
is antispasmodic and calmative to the nervous system. 
It possesses also antithermic and hypnotic properties. 



92 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

It is indicated in convulsions, hysteria, insomnia, epi- 
lepsy, tetanus, palpitations, etc. It is also very useful 
in bronchitis in cases in which the catarrhal element is 
associated with a spasmodic one. Dose, one to three 
granules, at suitable intervals, according to circum- 
stances. 

Narceine, — In granules containing one milli- 
gramme. Calmative, antispasmodic. Its uses are the 
same as those of codeine. Dose, six to twenty gran- 
ules daily. 

Mtrate of Pilocarpine. — In gran ales containing 
one milligramme. It is diaphoretic, sialogogue, and 
diuretic. It is useful in bronchitis, pleuritis, coryza, 
asthma, stomatitis, and pharyngitis. Dose, ten to 
thirty granules daily. 

Pepsin, — In granules containing one centigramme. 
An aid to digestion, which is given with the aim of 
supplying the deficiency as to gastric juice, or to aid 
the gastric forces. It is useful in dyspepsia, enteritis, 
etc. Dose, two to four granules with each meal. 

Phosphate of Iron, — In granules containing one 
centigramme. By virtue of the iron it acts as a tonic 
to the blood, and by the phosphorus to the bones and 
nervous system. It is useful in chloro-ansemia, in 
rachitis, in the lymphatic diathesis, during convales- 
cence, etc. Dose, six to twelve granules daily. 

Phosphite of Zinc. — In granules containing one 
milligramme. A tonic to the nervous system. It is 
useful in all the forms of nervous debility, in scrofula, 
tuberculosis, etc. Dose, five to fifteen granules daily. 

Picrotoxine. — In granules containing one half a 
milligramme. It has a calmative effect upon the bul- 
bar centers, and is a stimulant to therm ogenesis, being 
manifested by symptoms of congestion upon the face. 
It is applicable in different spasmodic affections of the 
respiratory centers, of which asthma, whooping-cough, 
etc., will serve as examples. In cases in which there 
is pleuritic effusion, it also relieves dyspnoea and favors 



PHARMACOLOGICAL MEMORIAL. 93 

the resorption of the effusion. Dose, in acute condi- 
tions, one granule every hour until the effect is ob- 
tained ; in chronic conditions, two to three granules 
two to three times daily. 

Piperine. — In granules containing one milli- 
gramme. It stimulates the digestive functions, and 
those of mucous membranes as well. It is useful in 
anorexia, blennorrhoea, and chronic bronchitis. It is 
contra-indicated in irritative conditions of the gastro- 
intestinal canal. Dose, one to two granules three to 
five times daily. 

Podophyllin. — In granules containing one centi- 
gramme. Its cholagogue and purgative action can be 
relied upon, though it comes on slowly and without 
the production of colicky pains. It is of use in consti- 
pation, intestinal occlusion, gastritis, and icterus. Dose, 
in acute cases, three granules every hour until the de- 
sired result is obtained ; in chronic cases, three to five 
granules before going to bed at night. As a purgative, 
five granules may be given every half-hour, for three 
or four doses. 

Protiodide of Mercury. — In granules containing 
one centigramme. It is cholagogue and antisyphilitic. 
Dose, three to fifteen granules daily. 

Quassine. — In granules containing one milli- 
gramme. It is a bitter tonic, stomachic, and regulator 
of the biliary excretion. It is useful in all conditions 
of weakness and atony, in anorexia, and in most forms 
of dyspepsia, in conditions of convalescence, and as a 
stimulant to digestion, especially if there is a tendency 
to a hypersecretion of mucus on the part of the gas- 
tric glands. When combined with hyoscyamine or 
morphine, it mitigates the stupefying action of those 
alkaloids. It is very useful in that form of gastric 
catarrh to which drunkards are subject, in cough, in 
palpitations, and in that form of headache which is of 
gastric origin. Dose, one to five granules before each 
meal. 



94 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Salicylate of Ammonia. — In granules containing 
one centigramme. It is a most valuable antiseptic, and 
is of use in rheumatism and in all infectious and septi- 
cemic conditions. It is of use in cases in which there 
has been inoculation with poison, and for a fetid con- 
dition of the breath. Dose, one to three granules every 
two hours, or every hour in acute cases. 

Salicylate of Iron. — In granules containing one 
centigramme. It restores the blood to a healthy con- 
dition, and prevents decomposition. It is useful in 
chloro-ansemic conditions complicated with rheuma- 
tism, in dyspepsia attended with fermentation, in scor- 
butus, purpura, etc. Dose, two to three granules three 
to five times daily. 

Salicylate of Quinine. — In granules containing 
one centigramme. It is useful for the periodic symp- 
toms of all rheumatic and infectious diseases. Dose, 
ten to forty granules once or several times daily. 

Salicylate of Sodium. — In granules containing 
one centigramme. It is useful for rheumatic condi- 
tions, gout, and dyspepsia which is accompanied with 
fermentation. Dose, three to five granules two to three 
times daily. 

Santonine. — In granules containing one centi- 
gramme. It is the active principle of the semen contra, 
and is used to destroy intestinal parasites. Dose, six 
to fifteen granules for one or two evenings, in connec- 
tion with two to four granules of podophyllin, or with 
a Sedlitz powder. 

Scillitine. — In granules containing one milli- 
gramme. It is diuretic and expectorant in its action, 
and tends to diminish the viscosity of mucous dis- 
charges. It is employed in bronchitis of the dry form, 
in whooping-cough, and in heart-disease in which there 
is diminished flow of urine. Dose, one to two gran- 
ules every two hours, or less frequently in chronic cases. 

Sedlitz (effervescent). — A saline purgative com- 
bined with sugar, in a granular form. A small tea- 



PHARMACOLOGICAL MEMORIAL. 95 

spoonful may be taken daily as a mild cathartic ; or, 
as a purgative, a dessertspoonful may be taken every 
two hours in cold water until the desired effect is ob- 
tained. It may be used as an ordinary drink during 
the latter end of pyrexial troubles and infectious dis- 
eases. 

Subnitrate of Bismuth. — In granules containing 
one centigramme. It is an absorbent, an antispasmodic, 
and a disinfectant to the digestive apparatus. It is 
used in gastralgic forms of dyspepsia, in the chronic 
diarrhoea of children, and for eructations of an offensive 
character. Dose, five to ten granules, before eating. 

Sulphate of Atropine. — In granules containing 
one half a milligramme. Its action is the same as, 
though feebler than, that of atropine, and it is used in 
similar cases. Dose, one granule every half -hour until 
the desired effect is produced ; or, two to three gran- 
ules once or twice daily for incontinence of urine, epi- 
lepsy, the sweating of phthisis, etc. 

Sulphate of Calabarine. — In granules containing 
one half a milligramme. It increases the energy of 
contractility of the circular fibers ; it is useful in atonic 
conditions of the intestines. Dose, six to twelve gran- 
ules daily. 

Sulphate of Quinine. — In granules containing 
one centigramme. It is an antiperiodic which is useful 
in all paroxysmal diseases, but especially in the inter- 
mittent fevers. It has a tonic action upon contractil- 
ity. Dose, six to twenty granules, or more, daily. 

Sulphate of Strychnine. — In granules containing 
one half a milligramme. Its properties, uses, and doses 
are the same as those of the arseniate of strychnine. 
The sulphate is to be preferred if it is desired to obtain 
simply a neurosthenic effect. 

Sulphide of Calcium. — In granules containing 
one centigramme. It is the best of the parasiticides. 
It is indispensable in the treatment of all infectious 
diseases ; for example, croup, measles, variola, erysipe- 



96 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

las, cholera, etc. It is equally useful in catarrhal 
troubles, particularly in those of the respiratory appa- 
ratus. It is also of use in different dermatoses. Dose, 
one granule every quarter of an hour, in the acute 
stage ; two to five, three times a day, in the chronic. 

Tannate of Cannabine. — In granules containing 
one milligramme. It is obtained from Indian hemp, 
and is a valuable drug on account of its calmative and 
analgesic properties, while it has not the disadvantages 
of morphine. It may be used in gastralgia, and for all 
pains of a spasmodic character, when it is desirable to 
soothe and avoid excitation. Dose, for acute conditions, 
two granules every quarter of an hour until the effect 
is produced ; for chronic conditions, three granules 
three to five times daily. 

Tannate of Pelletierine. — In granules contain- 
ing one milligramme. If it is to be used as a tsenif uge, 
the granules should contain a centigramme. When 
used for the latter indication, ten to fifteen tubes may 
be taken in water at once, or at frequent intervals, and 
the dosage continued until twenty-five to thirty centi- 
grammes of the drug have been taken, this being the 
quantity which is requisite to expel the tsenia. It may 
also be used in certain congestive forms of headache. 
The dose for headache is five granules hourly until the 
effect is produced. In cases in which it is taken as 
a tsenifuge, a purgative should follow after a short 
period to facilitate the effect. 

Valerianate of Atropine. — In granules contain- 
ing one half a milligramme. It is antispasmodic, and 
is particularly indicated in neuroses of a convulsive 
character, and in cerebral ansemia. It is also effective 
in the different forms of vesania. Dose, one granule 
every half -hour until the desired effect is produced, in 
acute conditions ; two granules two or three times daily 
in chronic. 

Valerianate of Caffeine. — In granules containing 
one milligramme. It has an antispasmodic and anti- 



PHARMACOLOGICAL MEMORIAL. 97 

congestive action npon the brain. It may be used in 
headache, vertigo, cerebral torpor, etc. Dose, one to 
three granules every half-hour. 

Valerianate of Iron. — In granules containing one 
centigramme. It is useful in neuroses, chloro-ansemia, 
and those forms of ansemia which are accompanied by 
gastralgia and headache. Dose, one to three granules 
three times daily. 

Valerianate of Quinine. — In granules containing 
one centigramme. Its action is antiperiodic and anti- 
spasmodic. It is particularly useful in malarial or 
intermittent affections with nervous phenomena. It is 
an excellent tonic. Dose, two to five granules three to 
five times daily. 

Valerianate of Zinc. — In granules containing one 
centigramme. It is antispasmodic, and checks nervous 
mobility. It is useful in neuropathies in cases in which 
iron is contra-indicated. Dose, six to twenty granules 
daily. 

Veratrine. — In granules containing one half a 
milligramme. It is a calmative of muscular contrac- 
tility, a defervescent, and a contra-stimulant. It is 
of use in rheumatism, congestive dermatoses, chorea, 
and all febrile conditions in which the pulse is hard 
and full. In gastric troubles it tends to excite the ap- 
petite. For children it serves as an excellent emetic. 
Dose, one to three granules at suitable intervals, ac- 
cording to the case. 



LIST OF DISEASES AND 
CONSPICUOUS MOEBID ELEMENTS, 

WITH THE INDICATIONS FOR THOSE DOSIMETRIC DRUGS 

WHICH WOULD BE MOST APPLICABLE 

TO THE GIVEN CASES. 



LIST OF DISEASES AND CONSPICUOUS 
MORBID ELEMENTS. 



Accidents at the critical period 

Acne 

Acne sebacea . 

Acrinia, pancreatic 

Action, nervous 

Adynamia 

Agalaktia . 



Agony 
Albuminuria 
Algidity . 
Alienation, mental 
Alkalescence . 



! Stimulants 
Depressants 



( Increased 
( Depressed 



Amaurosis 
Amenorrhoea 



Plethoric 
Anaemic 
Spasmodic 
Tonic . 



Amnesia . 

Amygdalitis 



Aconitine. 

Sedlitz. 

Veratrine. 

Sulphide of calcium. 

Arsenious acid. 

Arseniates. 

Nitrate of pilocarpine. 

Calomel. 

Aconitine, hyoscyamine. 

Phosphoric acid,' strychnine. 

Sulphate of strychnine. 

Salicylate of ammonia. 

Arseniate of iron. 

Phosphate of iron. 

Hydrochlorate of morphine. 

Arseniate of strychnine. 

Aconitine. 

Digitaline. 

Hypophosphite of strychnine. 

Phosphoric acid. 

Tannate of cannabine. 

Hyoscyamine, digitaline. 

Salicylic acid. 

Tannic acid. 

Tannic acid. 

Aconitine. 

Tannic acid. 

Strychnine. 

Sulphate of strychnine. 

Anemonine. 

Aconitine, veratrine. 

Iron, strychnine. 

Hyoscyamine. 

Ergotine. 
{ Cubebine. 
( Atropine. 
< Aconitine. 
( Cocaine. 



102 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



Anaemia . 

Anaesthesia 

Anaphrodisia . 

Anasarca (dropsy), acute 

Aneurism 

Angina pectoris 

Anginae, acute . 
Anosuria . 



Apepsia . 
Apoplexia 

Appetite, for food 

Appetite, sexual 



Increased 

Diminished 

Increased 



{ Diminished 
Arrest of growth in children . 



Arthritis, chronic 

Ascites 



Asialorrhcea 



Asphyxia 
Asthenia 



Asthma . 

Asystolia . 

Ataxia 

Ataxia, partial muscular . 

Ataxia, progressive locomotor 
Ataxisystolia 



Arseniate of iron. 

Arseniate of manganese. 
j Hypophosphite of strychnine, 
( Phosphoric acid. 
j Strychnine. 
( Phosphide of zinc. 

Aconitine. 

Digitaline. 
j Digitaline. 
( Ergotine. 
( Daturine. 
( Brucine. 

Aconitine. 

Cocaine. 

Veratrine. 

Pepsin. 
j Ergotine. 
( Caffeine. 

Hyoscyamine. 

Quassine. 

Bromide of camphor. 

Strychnine. 
i Carbonate of lithia. 
■< Hypophosphites of lime and 
( sodium. 

Iodoform. 

Arseniate of strychnine. 

Nitrate of pilocarpine. 

Nitrate of pilocarpine. 

Quassine. 

Strychnine. 

Sulphate of strychnine, 
j Hyoscyamine. 
( Sulphide of calcium. 
j Digitaline. 
( Caffeine. 

j Bromide of camphor. 
( Gelsemine. 

Veratrine. 

Atropine. 

Phosphite and 
zinc. 

Digitaline. 



valerianate of 



Biliousness 

Blennorrhagia 

Blennorrhcea 



Sedlitz Chanteaud. 

Podophyllin. 

Aconitine. 

Helenine. 

Helenine. 

Strychnine. 



DISEASES AND REMEDIES. 



103 



Bodies, foreign, in the oesophagus . . Emetic. 

-r. r • ( Hyoscvamine. 

Bouhmia } Morphine. 

( Aconitine. 
Bronchitis •< Morphine. 

( Apomorphine. 

Bronchorrhcea \ ggj** •**»• 



Cachexiae .... 

Calculi, biliary and urinary 

Cancer 

Cancerous diarrhoea 

Carus 

Catarrh, dry pulmonary 

Catarrh of the stomach 

Catarrh, suffocative . 

Catarrhal affections . 

Cephalalgia 

Cephalalgia, rheumatismal 

Chlorosis . 

Cholera . 

Cholera, infantile 
Cholerine . 
Chorea 
Chyluria . 
Colic, hepatic . 

Colic, lead 



Arseniate of strychnine. 

Arseniate of iron. 

Benzoate of lithia. 

Hyoscyamine. 

Hydrastine. 

Cicutine. 

Salicylate of iron. 

Pepsin. 

Caffeine. 

Strychnine. 

Scillitine. 

Emetine. 

Veratrine. 

Quassine. 

Hypophosphite of strychnine. 

Piperine. 

Nitrate of pilocarpine. 

Atropine. 

Caffeine. 

Guaranine. 

Colchicine. 

Cyanide of zinc. 

Arseniate of iron. 

Arseniate of manganese. 

Phosphoric acid. 

Strychnine. 

Sulphide of calcium. 

Codeine, brucine. 

Hydrochlorate of morphine. 

Sedlitz. 

Brucine, morphine. 

Veratrine. 

Hyoscyamine. 

Strychnine. 

Quassine, 

Hyoscyamine. 

Salts of lithia. 

Podophyllin. 

Strychnine. 

Atropine. 



104 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



Congestion, atonic, of the brain 

Congestions 

Conjunctivitis, chronic 

Constipation . 

Contractures . 

Convulsions 

Convulsive state 

Cough, whooping 

Cramps 

Croup 
Cystinuria 
Cystitis, chronic 

Cystitis, from use of cantharidcs 



Deafness . 

Delirium, alcoholic . 

Dentition, painful . 

Depression, nervous 

Dermalgia 

Diarrhoea . 

Diathesis, hemorrhagic 

Diathesis, purulent . 

Diphtheria 

Dry tetter 

Dysentery 

Dysmenorrhoea 

Dyspepsia 



1) 



( Nitrate of pilocarpine. 
\ Strychnine. 

Aconitine. 

Sedlitz. 
j Arsenious acid. 
{ Iodoform. 
j Podophyllin. 
\ Sedlitz Chanteaud. 
j Hyoscyamine. 
\ Croton chloral. 
j Phosphoric acid. 
I Gelsemine. 

Hyoscyamine. 

Bromide of camphor. 
j Sulphide of calcium. 
( Helenine. 

Bromide of camphor. 

Hyoscyamine. 
j Sulphide of calcium. 
( Salicylate of ammonia. 

Juglandine. 
( Arbutine. 
( Helenine. 

{ Bromide of camphor. 
( Hyoscyamine. 



Aconitine. 

Cocaine, 
j Strychnine. 
( Digitaline. 

Cocaine. 

Codeine. 
j Phosphoric acid. 
I Sulphate of strychnine. 

Cicutine. 

Tannate of cannabine. 
j Morphine. 
( Strychnine. 

Ergotine. 

Arseniate of iron. 

Iodoform. 

Arseniate of sodium. 

Sulphide of calcium, 
j Arsenious acid. 
{ Arseniates. 
( Emetine. 
] Hyoscyamine. 
j Veratrine. 
I Hyoscyamine. 
j Pepsin. 
1 Diastase. 



DISEASES AND REMEDIES. 



105 



Dyspnoea . 








( Picrotoxine. 

( Hydrobromate of cicutine 


( Atropine. 


Dysuria -j Strychnine. 


( Bromide of camphor. 


Eclampsia, infantile 






E 


j Phosphoric acid. 

1 Hydrobromate of quinine. 


Eclampsia, puerperal 








j Morphia. 

( Bromide of camphor. 


Ecthyma, chronic 








j Juglandine. 

( Arseniate of potash. 


Eczema, chronic 








( Sulphide of calcium. 
( Arseniate of soda. 


Engorgement, chronic 








j Iodoform. 
' ( Arseniate of iron. 


Ephidrosis 








j Atropine. 
\ Strychnine. 


Epilepsy . 








j Atropine. 

( Bromide of camphor. 


Epistaxis . 








j Ergotine. 
' ( Tannic acid. 


Epizoaries 








Sulphide of calcium. 


Erethism, cerebral . 








( Aconitine. 
{ Digitaline. 


Erethism, sexual 








j Cicutine. 

( Bromide of camphor. 


Eruptions, recurrent 








j Sulphide of calcium. 
"j Picrotoxine. 


Erysipelas 








Sulphide of calcium. 


Esthiomene (rodent ulcer^ 








( Juglandine. 

1 Phosphate of iron. 


Excrescences, epidermic 








Salicylic acid. 


Expectoration, viscous 








j Scillitine. 
| Helenine. 


F 
Favus Sulphide of calcium. 










( Aconitine. 


Fever 








•< Veratrine. 
( Digitaline. 


Fever, eruptive 








Sulphide of calcium. 


Fever, intermittent . 








j Arsenious acid. 
' ( Arseniate of quinine. 


Fever, mucous . 








j Nitrate of pilocarpine. 
' I Sedlitz Chanteaud. 


Fever, pernicious 








j Sulphate of quinine. 
' { Arseniate of strychnine. 


Fever, puerperal 








j Aconitine. 

( Salicylate of quinine. 



106 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



Fever, typhoid . 




( Aconitine. 
" I Arseniate of strychnine. 


Fever, urethral 




j Aconitine. 
' ( Hydrobromate of quinine. 


Fever, yellow . 




( Aconitine. 

( Sulphide of calcium. 


Finger, numbness in 




Hypophosphite of strychnine. 


Fissures, anal . 




Daturine. 


Fistulas, anal . 




j Iodoform. 

( Arseniate of iron. 


Flatulence 




j Sulphate of strychnine. 
1 Euonymine. 


Flowers, white (leucorrha 


ja) . 


j Iodoform. 

( Arseniate of iron. 


Flux, menstrual 


j Excessive 
\ Deficient 


Ergotine. 
Veratrine. 


Galactorrhcea . 


G 


j Phosphate of iron. 
' ( Arseniate of strychnine. 


Gangrene, senile 




Hypophosphite of strychnine 


Gas, gastro-intestinal 




Nitrate of bismuth. 


Gastralgia 




j Tannate of cannabine. 

( Hydrobromate of morphine. 




Gastrodynia 




j Veratrine. 
( Quinine. 


Glossitis . 




Aconitine. 


Glycosuria 




j Cocaine. 

( Benzoic acid. 


Gout 


H 


j Salicylate of lithine. 
( Colchicine. 


Haemateinesis . 




Ergotine. 


Hemoptysis 




j Ergotine. 
( Veratrine. 


Haemorrhage . 




j Ergotine. 

( Sulphate of strychnine. 


Haemorrhaphilia 




j Ergotine. 

( Arseniate of iron. 


Haemorrhoids . 




j Aconitine. 
( Strychnine. 


Hernia, strangulated 




j Atropine. 
( Podophyllin. 


Herpes circinatus . 




Sulphide of calcium. 


Herpetism 




j Arseniate of soda. 
] Sulphide of calcium. 
j Lactate of iron. 


Hydraemia 




1 Arsenious acid. 



DISEASES AND REMEDIES. 



107 



Hydropsy . 

Hydrorrhachis 

Hydrothorax 

Hyperacusis 

Hyperosmia 

Hypersecretion 

Hypersystolia 
Hyperthermia 

Hypnosis . 

Hypoglobulia 

Hysteralgia 

Hysteria . 



pancreati 



j Digitaline. 
( Strychnine. 

Iodoform. 

Ergotine. 

Nitrate of pilocarpine. 
j Valerianate of quinine. 
I Narceine. 

Hydrobromate of morphine. 
j Morphine. 
( Hyoscyamine. 

Digitaline. 

Aconitine. 

Valerianate of atropine. 

Valerianate of caffeine. 

Arseniate of iron. 

Gelsemine. 

Hyoscyamine. 

Bromide of camphor. 

Valerianate of atropine. 



Ichthyosis . 
Impetigo, chronic . 

Incontinence of urine, nocturnal 

Indigestion 

Inertia, uterine 

Inflammations . 

Insomnia . 

Intertrigo . 



Arsenious acid. 
j Phosphoric acid. 
( Sulphide of calcium. 
(, Atropine. 
I Brucine. 
^ Emetic. 
( Pepsin. 
j Ergotine. 
( Strychnine. 
( Aconitine. 
\ Strychnine. 

Hydrochlorate of morphine. 

Tannate of cannabine. 
\ Tannic acid. 
( Veratrine. 



Laryngitis stridulus 

Leucocythoemia 

Leucorrhcea 

Lumbrici . 

Lupus 

Lymphatic diathesis 



Sulphide of calcium. 

Benzoic acid. 

Hydroferrocyanate of quinine. 

Arseniate of iron. 

Phosphate of iron. 

Iodoform. 

Santonine. 

Calomel. 

Iodoform. 
\ Juglandine. 
| Iodoform. 



108 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



M 



Meningitis, granular 


j Iodoform. 
* I Arseniate of quinine. 


Meningitis, infantile 


j Aconitine. 
* ( Hyoscyamine. 


Mentagra 


( Arseniate of potash. 
* ( Biniodide of mercury. 


Metritis, puerperal . 


j Aconitine. 
* I Salicylate of quinine. 


Metritis, simple 


j Aconitine. 
* ( Ergotine. 


Metrorrhagia .... 


j Ergotine. 
* ( Strychnine. 


Miasm 


j Sulphide of calcium. 
' ( Salicylic acid. 




j Quassine. 
' ( Caffeine. 


Migraine ..... 


Morphine, poisoning by . 


j Hyoscyamine. 
' l Caffeine. 


Muscarine, poisoning by . 


( Atropine. 
* ( Dat urine. 


Naevi materni .... 


N 

Ergotine. 


Nausea ..... 


{ Quassine. 
* 1 Codeine. 


Neuralgia .... 


j Aconitine. 
' l Hydrobromate of morphine. 


Neuralgia, cranial . 


j Cocaine. 
* ( Croton chloral. 


Neuralgia, general . 


j Cicutine. 
' ( Tannate of cannabine. 


Neuralgia, paludal . 


j Hydrobromate of quinine. 
* ( Valerianate of caffeine. 


Neuralgia, vesical . 


j Bromide of camphor. 
' I Helenine. 


Neuroses 


j Hyoscyamine. 
* ( Strychnine. 


Nicotine, poisoning by 


j Caffeine. 
* } Strychnine. 


Obesity 




j Strychnine. 
" ( Iodoform. 


(Edema . 


j Sulphate of strychnine. 
* I Digitaline. 


Oligsemia 


j Arseniate of iron. 
' ( Phosphoric acid. 


Oligocholia ..*... 


j Podophyllin. 
* ] Colchicine. 


Oliguria 


j Asparagine. 
' ( Arbutine. 



DISEASES AND REMEDIES. 



109 



Ophthalmia, scrofulous 

Orgasm, sexual 

Osteitis, scrofulous 

Osteomalacia . 

Otalgia 

Oxaluria . 

Ozaena 



j Arseniate of soda. 

I Iodoform. 

j Bromide of camphor. 

( Cicutine. 

\ Iodoform. 

I Hypophosphites. 

j Hypophosphite of lime. 

( Hypophosphite of soda. 

Hydrobromate of morphine. 

Cocaine. 
j Sedlitz Chanteaud. 
( Phosphoric acid. 
j Iodoform. 
I Sulphide of calcium. 



Pains 

Pains, spasmodic 

Palpitations 

Paludal poisoning 

Paralyses . 

Paraplegia 

Parasites . 

Peritonitis, puerperal 

Phlegmorrhagia 

Phosphaturia . 

Photophobia 

Pityriasis . 

Plethora . 

Pneumatosis 

Pneumonia 

Pollutions 

Polycholia 

Polyhsemia 



j Morphine. 

( Tannate of cannabine. 
j Bromide of camphor. 
( Hyoscyamine. 

Digitaline. 

Aconitine. 

Arseniate of quinine. 

Arseniate of caffeine. 
( Strychnine. 
( Phosphoric acid, 
f Phosphide of zinc. 
{ Colocynthine. 
( Sulphide of calcium. 
I Salicylates. 

Aconitine. 

Salicylate of quinine. 
j Atropine. 
( Morphine. 
i Sedlitz Chanteaud. 
} Asparagine. 

Daturine. 

Gelsemine. 
j Sulphide of calcium. 
( Arsenious acid. 
j Aconitine. 
"I Sedlitz Chanteaud. 
( Strychnine. 
} Quassine. 

Aconitine. 

Nitrate of pilocarpine, 
j Strychnine. 

~( Hydrobromate of cicutine. 
j Leptandrin. 
( Sedlitz Chanteaud. 

Aconitine. 

Sedlitz Chanteaud. 



110 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



Polyuria . 
Priapism . 
Prolapsus . 
Prosopalgia 
Pruritus vulvae 
Purpura . 
Pustule, malignant 
Putridity . 



Hydrochlorate of morphine. 

Gregory's salt. 

Bromide of camphor. 

Hyoscyamine. 

Ergotine. 

Sulphate of strychnine. 

Aconitine. 

Phosphide of zinc. 

Cicutine. 

Gelsemine. 

Ergotine. 

Valerianate of iron. 

Sulphide of calcium. 

Salicylate of ammonia. 

Salicylate of ammonia. 

Salicylic acid. 



R 



Rectum, inflammation of 
Rhachitis . . . . 
Rheumatic diathesis 
Rheumatism, acute . 
Rubeola (measles) . 



\ Daturine. 

\ Emetine. 

j Hypophosphite of lime. 

I Phosphate of iron. 

j Colchicine. 

\ Salicylate of soda. 

Colchicine. 

Veratrine. 
j Sulphide of calcium. 
( Salicylate of quinine. 



Scarlatina 
Sciatica . 
Scorbutic diathesis 
Scrofula . 
Secretions, biliary 
Secretions, gastric 
Secretions, intestinal 
Secretions, salivary 
Sensibility 
Septicaemia 



Excessive . 
Insufficient . 
Excessive . 
Insufficient . 
Excessive . 
Insufficient . 
Excessive . 
Insufficient . 
Increased . 
Diminished. 



j Sulphide of calcium. 
( Veratrine. 

Aconitine. 

Gelsemine. 
j Arseniate of iron. 
( Ergotine. 
j Juglandine. 
\ Iodoform. 

Sedlitz Chanteaud. 

Podophylline. 

Benzoate of lithia. 

Pepsin. 

Hydrochlorate of morphine. 

Elaterine. 

Sulphate of atropine. 

Nitrate of pilocarpine. 

Tannate of cannabine. 

Phosphoric acid. 
( Salicylate of ammonia. 
| Salicylate of quinine. 






DISEASES AND REMEDIES. 



Ill 



Sialorrhoea 
Somnolence 
Soporous habit . 

Spasm 

Spermatorrhoea 

Spleen, hypertrophy of 

Strychnine, poisoning by 

Suppuration . 



Sweating . 

Swellings, white 
Sycosis 
Syncope . 
Syphilitic eruptions 
Syphilis . 



Increased 
Diminished 



j Hyoscyamine. 
( Tannic acid. 

Caffeine. 
( Caffeine. 
\ Cocaine. 

j Valerianate of atropine. 
\ Bromide of camphor, 
j Hypophosphite of strychnine. 
( Hydrobromate of cicutine. 
j Sulphate of quinine. 
( Ergotine. 
j Hyoscyamine. 
{ Tannic acid. 
j Iodoform. 
( Arseniate of soda. 
j Sulphate of atropine. 
I Agaricine. 
j Aconitine. 
( Sulphide of calcium, 
j Juglandine. 
( Iodoform. 
( Arseniate of potash. 
\ Biniodide of mercury. 
( Phosphoric acid. 
I Sulphate of strychnia. 
{ Arsenious acid. 
( Protiodide of mercury. 
( Biniodide of mercury. 
\ Protiodide of mercury. 



Tenesmus . 
Terrors, nocturnal 
Tetany . 
Thermogenesis . 
Thirst 

Tic-douloureux 
Tic, indolent . 
Torpor, hepatic 
Trismus, of the newly 
Tuberculosis . 



Increased 
Diminished 



born 



Hyoscyamine. 

Emetine. 

Bromide of camphor. 

Valerianate of atropine. 

Bromide of camphor. 

Croton chloral. 

Aconitine. 

Picrotoxine. 

Quassine. 

Aconitine. 

Atropine. 

Aconitine. 
j Sulphate of strychnine. 
( Valerianate of zinc. 
j Jalapine. 
( Podophylline. 

Bromide of camphor. 

Gelsemine. 

Iodoform. 

Arseniate of iron. 



112 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



U 

j Arseniate of strychnine. 
Ulcers ....... -j phosphoric acid. 

TT . ( Sedlitz Chanteaud. 

Uraemia ....... -j B enzoate of lithia. 

tt it. m." 1. i Helenine. 

Urethritis, chronic j ^routine. 

V 

TT . . ( Daturine. 

Vaginismus ] Bromide of camphor. 

TX . ... \ Aconitine. 

Vaginitis } Helenine. 

__ . . ( Sulphide of calcium. 

Variola } Salicylates. 

( Caffeine. 
Vertigo -j "Valerianate of atropine. 

( Sulphide of calcium. 
Virus ( Salicylate of ammonia. 

. . ( Colchicine. 

Visceralgia j Aconitine. 

, r , , ( Podophyllin. 

Volvulus } Hyoscyamine. 

iQuassine. 
Sulphide of strychnine. 
Codeine. 



ELEMENTS OF 
DOSIMETRIC THERAPEUTICS. 

DOSIMETRIC PRACTICE. 



ELEMENTS OF DOSIMETRIC PRACTICE. 



Abscess of the Liver. — See Suppurative Hepatitis 
(under Hepatitis). 

Adenitis. — Adenitis, or ganglitis, is a very common 
disease, and is due to a great variety of causes which 
tend to irritate the tissues of lymphatic glands. What- 
ever its cause, the common effect is an inflammation ; 
therefore the dominant should consist in the use of 
aconitine to overcome the inflammatory element. When- 
ever the disease is due to the presence in the circula- 
tion of infectious material, as in erysipelas, variola, 
etc., it is better to discard the mode of treatment which 
regards only the local accident, and seek to obtain a 
cure by means of efficient pathogenic medication. 

The more intense the local inflammatory symptoms, 
and the more elevated the fever, the more frequently 
should aconitine be administered. After the fever has 
somewhat subsided, one granule every two hours will 
suffice. The induration due to congestion, which char- 
acterizes the first stage, should be combated with en- 
ergy in order to prevent its evolution during the subse- 
quent periods. Should we see the case in its earliest 
stage, we should aim to abort the disease ; and, with 
this end in view, should give one granule of aconitine 
every hour until the desired effect is obtained. Emol- 
lient and absorbent local applications are suitable for 
this condition, to facilitate the disappearance of hyper- 
semia. Among the resolvents we prefer iodoform dis- 
solved in collodion, and applied in such a way as to 
cover the affected gland. This formula might be used : 



116 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

5 lodoformi 2 grammes. 

Collodii elastici 30 u 

The pain which accompanies suppuration may be 
quieted by the hydrobromate of cicutine, two granules 
being given every half-hour until a sedative effect is 
obtained. For the fever give hydrobromate of quinine, 
in addition to aconitine, to combat the intermittent 
character which is usually present ; three to five gran- 
ules may be given every two hours. After the gland 
has suppurated, iodoform associated with arseniate of 
soda may be given in doses of two granules of each, 
four times daily. Chronic induration, which almost 
always follows scrofula or inflammation of the lym- 
phatic glands, will require the use of juglandine and 
of iodoform, three granules being given three or four 
times daily. Topically, iodoform and collodion may 
be used as already prescribed. 

Dominant. Inflammatory element . . Aconitine. 

' Congestive induration . . Aconitine. 

Pain Hydrobromate of cicutine. 

Fever Hvdrobromate of quinine. 

(Suppuration. . . • | It^e of soda. 
Chronic induration . . j ^Une. 

Albuminuria. — See Nephritis. 

Alienation, Mental (Vesania, Phrenopatliies). — 
For obvious reasons, it will be impossible to indicate 
the particular treatment for each variety of phrenopa- 
thy. The practitioner should always observe with 
the most careful attention the mental perturbations 
which result from material injuries to the brain, and 
should distinguish them from those which are purely 
functional, whether the vitality of the psychical organ 
is directly affected, or whether it is modified by the in- 
termediate influence of organs which are not directly 
associated with the work of the brain. In the first 
instance, those agents which modify nutrition, the 
iodides, iodoform, the arseniates, phosphides, zinc, 
iron, etc., will give desirable results only on condition 



ELEMEXTS OF DOSIMETRIC PRACTICE. \\% 

that the treatment is continued for a long time ; in the 
second case, the dynamic modifiers, if well selected, 
will give resnlts which are much more prompt and 
more manifest. The difficulty consists in defining with 
accuracy the essential quality and direction of the 
dynamic perturbation, and this difficulty is often in- 
surmountable, because the complication and multi- 
plicity of nervous phenomena do not readily permit an 
absolute detection of the want of primary equilibrium. 
If this elementary diagnosis is impossible, and we are 
unable to make trial of the entire series of vital modi- 
fiers until that one is found which will correct the 
want of equilibrium, we must begin by giving one of 
the principal agents of this series, either strychnine or 
hyoscyamine, until an effect is produced. If the action 
of strychnine, as far as its therapeutic effect is con- 
cerned, appears inappropriate, we must substitute hy- 
oscyamine for it, and vice versa. 

This is a kind of interrogation or exploration which 
is entirely prudent, and Dr. Burggraeve has very justly 
called it the touchstone method. However skillful the 
physician may be, he will often be obliged to resort to 
this method in order to find out accurately the way he 
should follow. The dosimetric method, by giving us 
the means of obtaining gradually effects which are 
progressive, is the only one which pursues this cau- 
tious plan of diagnosis without any risk to the patient. 

As the circulation has a great influence upon the 
brain, greater indeed than upon any other organ, we 
are compelled to resort to agents which will regulate 
it, for the phrenopathies may depend upon a mild con- 
gestion, or upon anaemia of some encephalic region. 
We should therefore give aconitine to combat hypere- 
mia ; morphine, strychnine, phosphoric acid, and arse- 
niate of iron to relieve anaemia ; and digitaline or caf- 
feine to regulate the distribution of the blood. These are 
the drugs which we will have occasion to use in obscure 
cases for the purpose of modifying nervous vitality. 



118 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

The mobility of nervous phenomena may cause us 
to lose, in a short period of time, the advantage of pro- 
longed treatment ; for the same reason, anaemia may 
be rapidly changed into congestion, or spasm trans- 
formed into paralysis. The inefficiency of treatment 
for many cases of vesania, which could be easily 
cured if proper regard were paid to anatomical condi- 
tions, can only be explained by the extreme facility 
with which dynamic troubles are transformed into 
those of an opposite character, thus giving rise to in- 
numerable combinations, by means of which the normal 
equilibrium may be disturbed. This mobility is to be 
combated by the cyanide, the phosphide, or the vale- 
rianate of zinc, joined with strychnine or brucine, selec- 
tion from these drugs to be made according as the 
phenomena of excitation or of depression predominate. 
If the effect of strychnine or brucine is of an exciting 
character, they may be replaced by caffeine, cocaine, 
or guaranine, which regulate the vital actions, and 
are therefore excellent modifiers of the cerebral func- 
tions. We will refrain from prescribing fixed doses 
for these different indications, for that can be estab- 
lished only by the study of each particular case. At 
one time it will be necessary to force the dosage until 
there is an extraordinary accumulation ; at another, to 
reduce it to proportions which are almost homoeopathic. 
We should observe, however, that this delay or even 
absence of effect after frequently repeated doses is due 
to a kind of apathy, or an inhibition, as to the action 
of drugs, in the given case ; on the other hand, in other 
cases, very small doses will quickly produce decided 
effects on account of an erethism with respect to the 
action of drugs. But as these modalities are very 
variable, it may happen that before increasing the 
doses the moment may be suddenly reached in which 
the dosage becomes efficient or even excessive. Hence 
the necessity of proceeding with great prudence, and of 
interrogating the vitality continually, in order that it may 



ELEMENTS OF DOSIMETRIC PRACTICE. 



119 



indicate to us with certainty the modifications which 
should be introduced into the therapeutic arrangement. 



^Hyperasmia 
Anaemia . 



^ ('Dominant. Want of nervous equilibrium 

m 



Variant. 



Nervous mobility 



Spasms . 

Atony and paralysis 

Encephalopathies . 



j Arseniate of strychnine. 
' Hyoscyamine. 

Aconitine. 

Digitaline. 

Arseniate of iron. 

Morphine, 
f Caffeine. 
J Guaranine. 
1 Cyanide of zinc. 
[ Valerianate of zinc. 
j Valerianate of atropine. 
( Gelsemine. 

Phosphoric acid. 

Ergotine. 

Iodides. 

Arseniates. 

Phosphides. 



Amenorrhoea. — The absence of menstruation may 
be accompanied by morbid phenomena, more or less 
complex in character ; or it may produce neither symp- 
tom nor inconvenience. It may be either permanent or 
transitory, and may depend upon organic lesions of the 
sexual organs, or upon a constitutional state. In the 
first case, haemorrhage from the cavity of the uterus is 
prevented by atresia of the genital organs ; in the sec- 
ond case there is no haemorrhage, and consequently no 
retention of blood. In the cases of atresia or obtura- 
tion of the cervix uteri, nothing can be done by the use 
of drugs, except to soothe the irritability of the uterus, 
which is caused by the permanent contact of the men- 
strual fluid, this irritability being especially marked at 
the menstrual epoch. We may give, then, cicutine and 
tannate of cannabine, three granules at a time, as often 
as seems necessary ; and, if there are painful contrac- 
tions with reflex phenomena, we can give one granule 
of hyoscyamine every half -hour. 

Changes in the constitutional condition sometimes 
give rise to amenorrhoea of a transient character. Such 
cases may be associated with chlorosis, in which iron 
would be indicated ; with tuberculosis, for which we 
would give iodoform ; with syphilis, for which we would 



120 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

give mercury ; with, polysarcia, for which we would pre- 
scribe suitable diet, exercise, and strychnine. The em- 
menagogues are contra-indicated in this condition. 



<$ t Permanent 

g /Dominant. J f Chlorosis . 

W ( TranmVnt J Tuberculosis 

03 J lransient < Polysarcia< 

[ Syphilis 
I Spasm 
I Pain . 



Variant 



1 Irritability 
Congestion 



Surgical measures. 

Iron. 

Iodine. 

Strychnine. 

Mercury. 

Tannate of cannabine. 

Hyoscyamine. 

Cicutine. 

Aeonitine. 



Amygdalitis. — The following remarks apply par- 
ticularly to the simple form of acute amygdalitis, which 
is the most frequent of all forms ; but we shall indicate, 
also, the differences in treatment which are imposed by 
morbid diathetic elements, which not only complicate 
the disease, but also render its medical treatment more 
complex. The disease is generally benign, but its treat- 
ment differs according to its duration and the presence 
of complications which aggravate the prognosis and 
make the disease itself less tolerable to the patient. A 
short time ago the proper treatment of this angina was 
believed to consist in the use of leeches and emollient 
or astringent gargles. These means are sometimes in- 
effective, if not actually harmful. The result of deple- 
tion is to weaken the tonsils, and consequently to pre- 
dispose to the development of the disease into a chronic 
form, and to frequent recurrence — though the imme- 
diate result is to soothe the patient, the final one is to 
prolong the disease. Gargles are objectionable, because 
they excite the inflamed organs to movements of a harm- 
ful character, and one can hardly hope that the tran- 
sient contact of not very active fluids will have much 
influence upon the progress of the morbid process. 
The rational treatment will necessarily consist in at- 
tacking the constitutional elements of the disease, in 
combating them wherever they show themselves, and 
in destroying those which cause the most suffering, or 
which have the greatest influence in producing and 



ELEMENTS OF DOSIMETRIC PRACTICE. 121 

maintaining the lesions of the disease. As in other 
diseases, therefore, we shall deal with the dominant 
and the variant. Chronic amygdalitis generally de- 
pends upon a morbid diathesis of some kind, and we 
ought, first of all, therefore, to aim at an alteration of 
the constitution, of such a character as shall affect the 
cause of the disease. 

The herpetic diathesis should be treated with the 
arseniates of soda or iron, or with arsenious acid, six to 
ten granules being given daily ; the syphilitic diathesis 
with the protiodide or biniodide of mercury ; the rheu- 
matic diathesis by the salicylates, by colchicine, or by 
iodoform, in doses of two granules, three or four times 
daily ; the scrofulous diathesis by hygienic means and 
by mineral waters, by juglandine, iodoform, arseniate 
of soda, and arseniate of iron ; the tuberculous diathe- 
sis, which usually depends upon a condition of leucocy- 
thsemia, by iodoform, arseniate of strychnine, and the 
ferruginous preparations. 

The acute forms of angina, of parasitic origin, are 
all curable by means of the sulphide of calcium, and 
even the diphtheritic form may be included in the list 
of curable diseases, thanks to the labors of Fontaine. 
For these forms of disease the sulphide of calcium can 
not be dispensed with. It may be associated with bru- 
cine, if there is adynamia ; with salicylate of quinine, 
if it occurs in periodical paroxysms ; with aconitine, if 
the fever is very high ; and with emetine, if the pres- 
ence of false membranes renders suffocation imminent. 
Simple tonsilar or acute catarrhal angina is best treated, 
as a rule, with aconitine. Its action is often remark- 
able, not only in reducing the temperature, but in re- 
lieving local hyperemia. The patient should be directed 
to allow the granules to dissolve slowly in the mouth, 
as the local effect upon the inflamed tonsils is thus 
increased. Thus, "taken at as frequent intervals as is 
indicated by the temperature, these granules take the 
place of both leeches and gargles, and are without their 



122 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

inconveniences. If the fever is not sufficiently high to 
require aconitine, cocaine may be used instead, three 
granules being taken every hour or two, according to 
the indications. 

Pain, which is often the first symptom, can be met 
satisfactorily with hyoscyamine, given in half-granule 
doses every quarter of an hour, until the desired effect 
upon the throat is produced. If the pain should not 
be present until after the fever has manifested itself, 
the aconitine or the cocaine will be sufficient to relieve 
it. Dryness of the throat will also be relieved by the 
aconitine or by the nitrate of pilocarpine, of which 
three granules may be given every half-hour. The 
gastric catarrh which often accompanies this disease 
may be treated with Sedlitz Chanteaud. After the in- 
flammation has become established and exudation has 
occurred, the fever must still be treated with aconitine. 
During the remissions hydroferrocyanate of quinine 
may be given. Codeine, two granules every quarter of 
an hour, will relieve the nausea accompanying this dis- 
ease ; while the ptyalism should be treated with small 
doses of atropine, repeated until the desired effect is 
obtained. In the third period, when the inflammation 
terminates by suppuration — a termination which will 
rarely occur, however, if the treatment of the disease 
be begun within the first twenty-four hours of its his- 
tory — the occurrence of chills will indicate the use of 
arseniate of quinine, one granule every hour, and ady- 
namia will call for a liberal use of tonics, especially 
strychnine. After the patient has recovered, we should 
endeavor to prevent all predisposition to renewed at- 
tacks by the use of strychnine and cold baths, if the 
tendency is to simple angina ; and by a prolonged anti- 
diabetic system of treatment, if the tendency is due to 
a morbid constitutional condition. The foregoing ob- 
servations will serve as a guide to the practitioner in the 
choice of suitable remedies for combating the different 
conditions which may arise in the course of this disease. 



ELEMENTS OF DOSIMETRIC PRACTICE. 



123 



CO 

I— I 

H 



Dominant. 



Herpetic diathesis 

Syphilitic diathesis . 
Rheumatic diathesis . 

Scrofulous diathesis . 
Tuberculous diathesis 



y Parasitic infection (diphtheria, 
measles, erysipelas, variola, etc.) 
( Pain 



Variant. 



/ 1st period : 
Congestion. 

2d period : 
\ Inflammation. 



3d period : 
^Suppuration. 



•< Dryness . 

( Gastric catarrh 

Fever 

1 Nausea . 
[_ Ptyalism 

( Chills . 
( Adynamia 



Arseniate of soda or 
iron. 

Arsenious acid, 
j Protiodide of mercury. 
( Biniodide of mercury. 
j Salicylate of quinine. 
"( Colchicine. 

{Arseniate of soda or 
iron. 
Iodoform. 
( Iodoform. 

-j Arseniate of strych- 
( nine. 

j Sulphide of calcium. 
( Salicylate of quinine. 

Hyoscyamine, cocaine. 

Aconitine. 

Sedlitz Chanteaud. 
j Aconitine, hydroferro- 
( cyanate of quinine. 

Codeine. 

Atropine. 
( Arseniate of quinine. 
< Arseniate of strych- 
r nine. 



Aiisemia. — Clinically, anaemia may be considered 
under three distinct and well-defined forms. 

First, anaemia proper, in which the condition is due 
to the loss of a greater or smaller quantity of blood by 
haemorrhage. 

Second, cachectic ancemia, which is the result of the 
introduction into the blood of principles which are for- 
eign to it, or of the insufficient elimination from it of 
substances which should be excreted. In both cases 
a modification in the composition of the blood, of the 
nature of a dyscrasia, is effected, and, consequently, a 
defective alimentation of the red globules. 

Third, essential anamia, or chlorosis, which is a 
disease of the red globules themselves, or of the organs 
which produce them. 

Anaemia proper is quickly transformed into hydre- 
mia. The cause being removed, the patient will get 
well spontaneously, in a longer or briefer period, ac- 
cording to the condition of the digestive functions, if 
he has offered successful resistance up to that point. 
Our aim should therefore be to preserve and excite the 
appetite, by stimulating the contractility of the intes- 



124: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

tinal tube by the use of quassine and strychnine, and 
facilitating digestion artificially, by the use of pepsin 
and diastase. With an active stomach and the use of 
proper food, the normal state of the blood will be read- 
ily re-established, and there will be no occasion for em- 
barrassing the digestive functions by the administration 
of iron, which is contained in the food in sufficient 
quantity to meet the exigencies of the case. In cachec- 
tic anaemia the cause must be treated ; the daily use 
of Sedlitz Chanteaud, as a diuretic and laxative, and of 
strychnine to sustain the vitality and excite the nutri- 
tive functions, will be found to be the most appropriate 
remedies. 

Chlorosis, that form of ansemia which is so common 
at the present time, is usually treated with iron, but 
the utility of this means of treatment for such a condi- 
tion remains to be proved. When we see that the cura- 
bility of chlorosis depends much more upon the regular 
production of hsemotoblasts than upon the methodical 
administration of ferruginous preparations ; when we 
observe that in those cases of chlorosis which are most 
pronounced the deficiency of iron in the blood is quite 
insignificant compared with the large quantities which 
are taken in with the food, and in pharmaceutical 
preparations ; when we consider that hygienic means 
— cheerfulness, good air, sunshine, and cold water — are 
superior to preparations of iron for the treatment of 
chlorosis, we may be pardoned for having some doubt 
with respect to the specific virtue which is usually at- 
tributed to iron. It may happen, in chlorosis, either 
that the hsematoblasts, after a time, are produced in 
sufficient quantity, or with a sufficient degree of vital- 
ity, to accomplish the regeneration of the blood-glob- 
ules, in which case the disease is quickly cured ; or, on 
the other hand, that the production of the hsemato- 
blasts is defective, the preparations of iron exercising 
no perceptible benefit, in which case the ansemia be- 
comes pernicious, incurable, and rapidly fatal. Though 



ELEJIEXTS OF DOSIMETRIC PRACTICE. 125 

therapeutics can not interfere directly in the production 
of the hsematoblasts, it can render good service by its 
direct influence upon the general vitality, and upon the 
digestive functions in particular. In chlorosis the vital 
energy is profoundly depressed. All the functions are 
deficient in activity, on account of the languor and the 
sluggishness of the nerve-force. The muscular system 
does not escape this torpid condition, and gastrointes- 
tinal inertia is manifested by the customary symptoms. 
The lesion of the digestive apparatus is the principal 
obstacle to the rapid cure of chlorosis, for, without per- 
fect elaboration of the food, without its rapid and com- 
plete absorrjtion, we can not hope for a general recon- 
struction of the system, which is indispensable to a 
proper reorganization of the blood. Herein the ques- 
tion as to the utility of iron becomes most pertinent. 
Its absorption is open to doubt ; the larger portion, if 
not all of it, being recoverable from the faeces. By its 
astringent action, which is exercised throughout the 
entire surface of the digestive tract, and propagated by 
means of the centripetal nerves throughout the entire 
economy, we can readily explain not only the improve- 
ment in the working of the digestive apparatus which 
follows its use, but, in addition, the general tonic effect 
which follows its prolonged use. In the same manner, 
it is easily explained that iron has equivalent succe- 
danea in hydrotherapy, strychnine, gymnastics, change 
of air, etc. The indication in chlorosis is, therefore, to 
stimulate to action. In addition to hygienic means, we 
may use iron, the astringents, and the bitters — strych- 
nine, quassine, tannic acid, and quinine being preferred. 
The strychnine may be associated with iron, but the 
other three must not be so used on account of chemical 
incompatibilities. The dosimetric arsenal has several 
ferruginous preparations — the arseniate, phosphate, 
lactate, valerianate, and salicylate. All of them may 
be used, either singly or in combination, according to 
the indications of each case. The arseniate is suitable 



126 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

in most diseases ; of all the salts of iron it is the most 
readily tolerated, and is least apt to give rise to consti- 
pation. It is appropriate in the most simple forms of 
chlorosis. Its combination with arsenic is very advan- 
tageous. Two or three granules may be given with each 
meal. The phosphate will be found serviceable in cases 
in which the nervous functions are much depressed. 
The lactate is indicated if the stomach is very irritable, 
with a tendency to gastralgia. The valerianate may be 
used in those forms of chlorosis which are complicated 
with neuralgia or other nervous troubles. If a rheu- 
matic element is present, or there is tendency to rapid 
decomposition in the stomach, the salicylate may be 
used. The number of granules to be taken at each dose 
is the same, whichever salt be employed. As a rule, 
two of these salts are used in combination, their action 
being fortified by the use of the arseniate or the hypo- 
phosphite of strychnine, one or two granules, three 
times daily. If digestion is difficult, we should employ, 
in addition, three granules each of pepsin and of diastase 
with each meal. Such is the fundamental treatment of 
anaemia. As the symptoms vary, we shall be compelled 
to complicate the treatment. Palpitations, which occur 
so often among chlorotic individuals, and which fre- 
quently destroy the good effect of medication, on ac- 
count of the moral troubles which have so depressing 
an action on the sick, should be promptly antagonized 
with digitaline. Gastralgia, whether it be spontaneous 
or produced by iron, should be treated with codeine, 
associated with hyoscyamine, three granules of the for- 
mer and one of the latter being used, at the same time 
with the preparations of iron. If the pain is very se- 
vere, two granules of morphine, with one of sulphate 
of atropine, may be used every quarter of an hour until 
the pain ceases, or from three to ten granules of cocaine 
may be taken in the course of ten minutes. Headache 
and vertigo may occur, whether from congestion or 
cerebral ansemia. If due to the former, a granule of 



ELEMENTS OF DOSIMETRIC PRACTICE. 



127 



aconitine, given hourly, will relieve the congestion ; if 
due to the latter, those means should be used which 
will restore to the brain the necessary blood-supply. 
Of these, caffeine, two granules every quarter of an 
hour, may be used ; or bromide of camphor, or benzoate 
of ammonia, in similar doses ; or two granules of Greg- 
ory's salt may be given every half-hour. For the more 
or less periodic neuralgias, which may be present from 
time to time, five granules of the valerianate of quinine, 
every half-hour, may be used, until the appearance or 
the want of appearance of the paroxysm. Irregular 
forms of neuralgia will be more appropriately treated 
by guaranine and gelsemine, two granules every quarter 
of an hour. Amenorrhcea should be met with iodo- 
form, associated with arseniate of iron, three granules 
three times daily ; menorrhagia by three granules of 
ergotine, one to three of sulphate of strychnine, and 
three granules of tannic acid, every half-hour, or of t- 
ener, according to the merits of the case. For consti- 
pation, three to five granules of podophyllin may be 
given every evening, or three granules of euonymine 
before each meal. 

Quassine. 

Arseniate of strychnine. 

Pepsin and diastase. 

Sedlitz Chant eaud. 

Hypophosphite of strychnine. 

Salts of iron (arseniate, phosphate, 
lactate, valerianate, salicylate). 

Tannic acid. 

Arseniate or hypophosphite of 
strychnine. 

Digitaline. 

Codeine and hyoscyamine. 

Hydrobromate of morphine and 
sulphate of atropine ; cocaine. 

Aconitine. 

Gregory's salt, benzoate of am- 
monia, bromide of camphor. 

Valerianate or hydrobromate of 
quinine. 

Gelsemine and guaranine. 

Podophylline, euonymine. 

Iodoform. 

Ergotine, tannic acid, sulphate of 
strychnine. 



('Anaemia proper 
Cachectic anaemia 



Dominant. ( Essential anaemic chloro- 
sis .... 



Palpitations . 
k Gastralgia 

Cephalalgia | ^stive 



Variant. ( a gia -j j rre g U i ar 

Constipation . 
Amenorrhcea . 



Menorrhagia . 



128 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Cerebral Anaemia.— Cerebral anaemia results now 
from general anaemia, in which the brain participates, 
and again from a particular ischaemia of the brain, 
localized in that organ, without the other organs being 
affected. In both forms the dominant indication is the 
same — to increase the circulation of blood within the 
brain — but in the first form the primary cause must also 
be considered ; otherwise, the results of treatment will 
be very transitory. 

That is why the ferruginous preparations, and all 
other substances which are designed to improve the 
condition of the blood, should accompany and follow 
the use of the agents which are particularly indicated 
for this condition, and which constitute the treatment 
for the emergency. The active principles of opium, 
by virtue of their power of increasing the cerebral cir- 
culation, will satisfy the first indication. Our choice 
would be Gregory's salt or the hydrochlorate of mor- 
phine, two granules from two to five times daily, and 
in case of children a granule of codeine, three to five 
times daily. If the anaemia is general, we should give 
two granules of the arseniate of iron three times daily, 
combined with Gregory's salt. Among the symptoms 
of cerebral anaemia there are some which call for a 
particular line of treatment, not only because they are 
very inconvenient for the patient, but also because 
they continually threaten his very existence. Thus, 
we should antagonize vertigo with caffeine or its salts, 
two granules every half-hour. If the vertigo is very 
distressing, or is frequently repeated, syncope may be 
the result, which is not always without danger, and 
which will be likely to terrify the patient. When 
the repetition of these attacks of syncope has demon- 
strated the weakness of the heart and the decided 
depression of nervous force, we should give one to two 
granules of hypophosphite of strychnine every hour. 
Convulsions should be treated with two granules of 
the bromide of camphor every two hours, or two gran- 



ELEMENTS OF DOSIMETRIC PRACTICE. 129 

ules of the valerianate of quinine every hour. If there 
is headache, we should give two granules of quassine 
every half -hour. The nausea which usually accom- 
panies vertigo may be treated with two granules of 
codeine every half -hour, or with two granules of quas- 
sine every hour in case the tongue is foul. Insomnia, 
which is one of the most distressing elements of this 
disease, should be treated with three granules of the 
hydrochlorate of morphine every quarter of an hour, 
or with the bromide of camphor in the same doses if 
for any reason it is not desirable to use the morphine. 
Narceine or croton chloral may be substituted for the 
other hypnotics should it seem desirable, the doses 
being the same as were prescribed for morphine. 
This treatment is almost always crowned with good 
results, unless the anaemia depends upon incurable 
organic lesions. The difficulty consists not so much 
in treating the anaemia as in differentiating that condi- 
tion from congestion. The symptoms by which these 
two opposite conditions are manifested are really the 
same, and it is not by this means that we can estab- 
lish a differential diagnosis. The general condition of 
the patient and the state of his vitality, as revealed by 
his pulse, are better signs than all the others. It is by 
these means that the physician ought to reach a decis- 
ion, and that without delay, for the results will be good 
or bad according as the conclusion in each case shall 
conform or fail to conform to the facts. A substantial 
diet, with abstinence from all causes which produce 
debility, are appropriate in anaemia ; a rigid diet is 
suitable in hyperaemia. The difference in the condition 
of the patient as the position of his body is changed is 
also an excellent means of differential distinction, but 
the differences are not always sufficiently appreciable, 
unfortunately, to constitute this a positive element of 
diagnosis. The physiological groping along, by means 
of medicaments as a touchstone, will also help the 
physician in finding the right course. 



130 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



< 

s 




| Anaemia . 


j Arseniate of iron. 
" \ Gregory's salt. 


Dominant. 


/ Vertigo . 


Caffeine. 




I Convulsions 


j Valerianate of quinine. 
' ( Bromide of camphor. 


^ 




\ Cephalalgia 


Guaranine. 






( Nausea 


j Codeine. 
* ( Quassine. 


PQ 






W 


^VARIANT. 


■j Syncope . 


Hypophosphite of strychnine. 


o 




( Insomnia . 


Hydrochlorate of morphine. 



Angina Pectoris. — See Lesions of the Heart. 

Angina, Pseudo-membranous. — See Diphthe- 
ritic Maladies, Tinder M. 

Apoplexy, Cerebral.— See Cerebral Haemorrhage, 
under Haemorrhage. 

Apoplexy, Serous,— See Hydrocephalus. 

Asthma. — Asthma has for its essential cause the 
abnormal excitability of the vagi, whence a spasmodic 
condition of the muscles which participate in the act 
of inspiration results. If the excitability of these 
nerves is very great, only a slight irritation is neces- 
sary to provoke a paroxysm of asthma ; if, on the 
other hand, their excitability is only ordinary, a par- 
oxysm will be caused only by a very decided irritation. 
It is very important to understand the causes which 
are at work in the latter case, for then it will suffice to 
suppress the determining cause of the paroxysm in 
order to control the predisposition to this disease, or, 
in other words, to keep it in a latent condition, which 
is equivalent to a cure ; and this will facilitate the 
action of the therapeutic agents upon the nervous 
lesion, which is at the foundation of the disease. 

M. Germain See classifies the causes of asthma in 
the following manner : 

A. Paroxysms originating from irritation of motor 
nerves : 

1. Impressions received from organic substances in 
the form of powder. 

2. Action of vapors of certain kinds. 

3. Influence of the atmosphere. 



ELEMENTS OF DOSIMETRIC PRACTICE. 131 

B. Paroxysms of reflex origin : 

1. The stomach and intestines. 

2. The uterus or its annexa. 

3. The skin and the sensory nerves. 

C. Paroxysms of central origin : 

1. Moral emotions. 

2. Medullary lesions. 

D. Paroxysms of humoral or mixed origin : 

1. Alteration of the blood. 

2. Poisoning. 

3. Constitutional faults. 

Idiopathic asthma, which is the consequence of a 
dynamic lesion of the pneumogastric nerves, or of their 
bulbar center, is not so difficult to cure as is usually 
supposed. The spasmodic character of the disease re- 
quires for a dominant hyoscy amine or the analogous 
alkaloids, atropine and daturine. With a methodical 
and prolonged plan of treatment, the paroxysms will 
diminish in frequency and intensity, until finally they 
will cease altogether. 

A distinction must be made between the treatment 
which is appropriate during the paroxysm and that 
which is appropriate during the intervals. The patient 
should avoid most carefully at all times all provoking 
causes which can stimulate the pneumogastric either 
directly or indirectly. In addition, we should combat 
the general condition of nervous excitability by the 
use of two granules of hyoscyamine twice daily, the 
number being gradually increased if, after a month of 
systematic treatment, no decided result is apparent. 
Should the asthma appear in a subject with the her- 
petic, rheumatic, or arthritic diathesis, the treatment 
should be of such a character as to modify the diathesis. 
For the herpetic diathesis we should use hyoscyamine 
or arsenious acid, six granules daily ; for the arthritic 
and rheumatismal, four granules of colchicine daily. 
In all cases we should also give Sedlitz Chanteaud in 
the morning, and in the evening two to four granules 



132 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

each of aconitine and digitaline. During the paroxysm, 
whatever its cause may have been, the treatment should 
be entirely different. The latent excitability of the 
vagi becomes active and apparent, and results in a loss 
of equilibrium of nervous force, which is most evident 
in those muscles which are innervated by the pneumo- 
gastric, certain other muscles being in a condition of 
tetanus. Hence arise certain phenomena which are 
commonly observed in connection with this disease : 
whenever there is a development of dynamic force in 
one portion of the organism, there is, of necessity, in- 
hibition in another, which is more or less closely related 
to the previous manifestation. To these two lesions we 
must oppose agents which will serve to ameliorate them, 
though their respective action may seem antagonistic. 
We should combat the spasm with one granule of hy- 
oscyamine, atropine, or daturine, every quarter of an 
hour, or less frequently, according to the intensity of 
the spasm. Of the three alkaloids, hyoscyamine is the 
least active ; daturine produces its effect the most rap- 
idly, and the effect of atropine is intermediate. The 
action of the sulphate or the valerianate of atropine is 
much less intense than that of the alkaloid itself. Pa- 
ralysis should be combated with the hydroch] orate or 
the hydrobromate of morphine, either alone or associ- 
ated with the sulphate or arseniate of strychnine ; three 
granules of morphine and one of strychnine may be 
given with each dose of hyoscyamine. Hypodermic 
injections of five to ten granules (in solution) of the 
hydrochlorate of morphine, with which one or two 
granules (in solution) of atropine should be associated, 
operate with great rapidity, and will produce a sooth- 
ing effect upon the patient in a very few minutes. 
Since it is a matter of common observation that the 
diminution in the intensity of the paroxysm is associ- 
ated with the secretion of a greater or smaller quantity 
of viscid mucus, we should endeavor to excite the ac- 
tivity of this secretion by the use of three granules of 



ELEMENTS OF DOSIMETRIC PRACTICE. 133 

sulphide of calcium every half-hour, or by similar doses 
of iodoform. These two drugs tend not only to stimu- 
late the secretion of the bronchial mucous membrane, 
but also to soothe the nerves which are distributed to 
the mucous membrane. Such is the ordinary treatment 
of these paroxysms, and ordinarily it is followed by the 
best results. It may occur, however, that the physio- 
logical effects of the drugs which have been prescribed 
will be apparent before their therapeutic ones, in 
which case their use must be suspended for the time ; 
in such cases three granules of bromide of camphor 
might be used every quarter of an hour, or two granules 
of lobeline every half-hour. The action of the lobeline 
is a complicated one, for, by its narcotic action, it has 
a soothing effect upon respiratory perturbation, while, 
by its local irritant action, it directs to the stomach the 
nervous activity which is accumulated in the respiratory 
apparatus, and thus, in an indirect manner, calms the 
paroxysmal condition. 

During the height of the paroxysm the pulse be- 
comes precipitous, the lungs congested, and there may 
be a rapid development of temperature, reaching even 
40° C. Under such circumstances, digitaline should be 
given to regulate the pulmonary circulation, and it 
should be associated with aconitine, one granule of each 
being given every hour, if the congestion is intense. 
Whatever be the importance of treatment during the 
paroxysm, we must not count too much upon its value, 
unless a continuous plan of treatment is associated with 
it, which shall aim at destroying the efficient cause 
of the disease. Unfortunately, in this as in all other 
chronic diseases which are characterized by acute par- 
oxysms and long intervals of relief, the patient too 
often believes that he is cured if he goes for any con- 
siderable period of time without an attack, and relaxes 
his course of medication accordingly. The physician 
should insist, as a condition of treatment which is de- 
signed to effect a cure, upon a rigorous observance of 



134: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

all his directions for a sufficiently long time — that is, 
until the evidence is satisfactory that a radical cure 
had been accomplished. The dread of medicines, with 
which physicians of the regular school have inspired 
their patients, is the greatest obstacle in the way of 
obtaining good results from treatment for their patients. 
If physicians would see to it that empty medicine-bot- 
tles were thrown away, instead of accumulating and 
frightening their patients (on account of the quantity 
of medicine which has been consumed), the patients 
themselves would have more perseverance in following 
treatment than they are wont to show. In the treat- 
ment of chronic and rebellious diseases, in which there 
is no irremediable vital lesion, it may often be observed 
that the failure to effect a cure is due to this very want 
of perseverance, and in no disease is this statement 
better illustrated than in asthma. 



/Dominant. 



\ Variant. 



j Excitability of the pneu- 
1 mogastric 
{Rheumatic diathesis 
I Herpetic diathesis . 
- Hemorrhoidal, hepatic 

congestions, etc. . 
v Other influences 
/ Gastro-intestinal aura 



S 
o 

S 



Spasm in inspiration 



Catarrhal secretion . 

Cardiac perturbations 
Congested condition 
Periodicity of the parox- 
ysms . 



Hyoscyamine. 

Colchicine. 

Sedlitz Chanteaud. 

Sedlitz Chanteaud. 

Aconitine. 

Suppression of the cause. 

Lobeline. 
["Atropine, daturine, mor- 
phine, arseniate of 
] strychnine, bromide of 
[ camphor. 

j Sulphide of calcium, iodo- 
( form, scillitine. 

Digitaline. 

Aconitine. 
j Hydro bromate of qui- 
( nine. 



Asystolie (or Asystolia). — See Cardiectasis. 

Athrepsis. — See Pultaceous Stomatitis (under Sto- 
matitis). 

Balanitis. — Balanitis is caused by inflammation of 
the glans penis, or of the preputial mucous membrane, 
a muco-purulent material being secreted, the fetid char- 
acter and deleterious action of which depend upon the 
length of time that it is retained between the glans 



ELEMENTS OF DOSIMETRIC PRACTICE. 135 

and the inner surface of the prepuce. Its principal 
causes are want of cleanliness of the penis, frequent 
erections and coitus, and syphilitic or herpetic ulcera- 
tions. This disease is usually benign in character, but 
it is less so the greater the difficulty in disposing of the 
products of secretion. If the glans is ordinarily covered 
by the prepuce, and the orifice of the latter is small, 
the superadded inflammatory swelling will almost en- 
tirely prevent the exit of the smegma and the products 
of inflammation. The contact of the urine aggravates 
the condition, and may readily assist in the develop- 
ment of phimosis, paraphimosis, or even gangrene of 
the glans. The indications depend, of course, upon the 
condition or stage of the disease. For the inflammation 
itself we should use aconitine ; as a curative as well as 
preventive means to the decomposition of the muco- 
purulent secretion we should use astringent and anti- 
septic washes and injections. As the condition is some- 
times complicated by spasm, we should also use hy- 
oscyamine. The pruritus, which often accompanies 
diseased conditions of the glans penis and frequently 
excites masturbation, may be treated by cicutine and 
local emollient applications. The quantity of aconitine 
given must be governed by the intensity of the inflam- 
mation. One granule every two hours will usually 
have the desired antiphlogistic effect. For lotions and 
washes, decoction of mallows or simple warm water 
may be used ; sulphate of zinc, with or without resor- 
cin, will furnish the basis for a satisfactory injection 
material. The following formula is recommended : 

9 Aquae 200 grammes. 

Resorcinse 2 " 

Zinci sulphatis 1 gramme. 

Should there be a condition of local spasm, one 
granule of hyoscyamine may be taken every two hours. 
For pruritus, one granule of cicutine may be used every 
two hours, or of tener if necessary. Balanitis of syphi- 
litic origin should be treated with iodide of mercury 



136 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

internally, and locally by injections of sublimate. Her- 
petic balanitis may be treated by two granules of the 
arseniate of soda, and two of veratrine, three to five 
times daily, and by the topical use of emollients. 

co J Dominant. Inflammatory element . Aconitine. 

. Arseniate of soda, veratrine. 

. Protiodide of mercury. 

. Cicutine. 

. Hyoscyamine. 

. Local use of antiseptics. 



EH / f Herpes 

S I I Syplrilis 

<j \ Variant. *J Pruritus 

^ | Spasm . 

2 I Fetid secretions 



Beri-Beri. — This disease is principally seen in 
tropical countries, and in this work it is referred to 
chiefly on account of its prevalence in Brazil.* 

The symptomatology and etiology of this disease 
lead us to believe that it is caused by a parasite which 
attacks principally the spinal cord. The existence of 
these specific (?) microbes appears to end with a change 
of climate on the part of the patient, and only the con- 
sequences of their existence remain, the persistence of 
which appears to be due to the destruction of certain 
nerve- cells, which appear to be completely regenerated 
after a certain length of time and suitable treatment, 
and all the functions are re-established as at the first. 
The dominant in the treatment will consist, then, in the 
use of strychnine to restore the structure and the func- 
tion of the nerve-cells. 

Among the salts of strychnine, a hypophosphite is 
to be preferred for this disease, two granules being 
given three or four times daily. The ansemic condition, 
which is almost always observed in these cases, calls for 
two to three granules of arseniate or the phosphate of 
iron with each meal, The accompanying oedema and 
palpitations will disappear more rapidly if the heart 
is strengthened by the use of caffeine and digitaline ; 
three granules of the caffeine may be given with one of 
digitaline, three to four times daily. The paralyses 
have already been treated by the dominant, and this 

* It is to be borne in mind that this work was originally written in 
Portuguese. — Te. 



ELEMENTS OF DOSIMETRIC PRACTICE. 



137 



treatment may be re-enforced by means of two grannies 
of phosphoric acid, three times daily. Two to three 
granules of podophyllin may be given at night for 
constipation. Two grannies each of cicutine and of 
croton chloral are indicated every hour, until a decided 
effect is produced, if the patient is troubled by intense 
or frequent neuralgias. The sense of occlusion or of 
constriction in the middle of the body, which sometimes 
occurs, should be treated by the same means. Hydro- 
therapy, and especially sea-baths, are almost indispen- 
sable if we wish to effect a rapid cure. The digestive 
troubles call for very attentive treatment, for upon the 
perfection of assimilation depends the ready regenera- 
tion of the anatomical elements which have been at- 
tacked or destroyed. We should, therefore, give quas- 
sine or brucine, two granules before each meal. Some 
authors consider this disease as a particular manifesta- 
tion of paludal infection. It will be proper, therefore, if 
the cases appear rebellious to treatment, and a change of 
climate does not effect satisfactory amelioration, to insist 
upon the use of two granules of the hydroferrocyanate 
or the arseniate of quinine, three to six times daily. 



Dominant. 



, Variant. 



Miasmatic infection 
Medullary lesions 

Digestive troubles 

Paralysis 

(Edema 

Anaemia 

Constipation 

Neuralgia 



Arseniate or hydroferrocyanate 

of quinine. 
Hypophosphite of strychnine. 
Quassine, brucine. 
Strychnine, phosphoric acid. 
Caffeine, digitaline. 
Arseniate of iron. 
Podophyllin. 
Cicutine, croton chloral. 



Blennorrhagia.— See Urethritis. 

Bronchitis. — This is one of the most common dis- 
eases, which is not only met in the daily work of the 
physician, but also occurs in numberless cases in which 
it follows the natural course, and is recovered from 
without medical attention, and often without regard 
for the simplest rules of hygiene. In spite of the fre- 
quency of the disease, a sure remedy, which shall be 
prompt in its action, remains to be discovered. Each 



138 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

year some new formula is recommended, based upon 
the experience of some distinguished physician, which 
may be used in almost any case which may present it- 
self, whatever its intensity. The care of the patients is 
regulated by custom, even to the cut of their clothing. 
Each autumn a new invention is launched upon the 
market, which will serve as a positive cure for the ca- 
tarrhal complications of the disease. It may be said 
that there is no disease which varies to the same extent 
as bronchitis in its types, its forms, its course, and its 
duration. While it is almost always benign, it is, not- 
withstanding, one which gives the physician great 
trouble, especially in regard to obtaining from the pa- 
tient knowledge which shall serve as a basis for intelli- 
gent treatment. Notwithstanding the fact that bron- 
chitis is benignant, as a rule, nothing is more important 
than that it should be checked at its beginning ; for, 
while it is usually a simple bronchitis at first, it may 
not be a bronchitis at all at the end — that is to say, 
from bronchitis are often developed pleurisy, pneu- 
monia, and tuberculosis, either of which may terminate 
fatally. Acute bronchitis rarely begins as such ; it 
usually follows coryza, laryngitis, or tracheitis. It is, 
therefore, plain that, if we were to check these prelimi- 
nary forms of disease while they are still localized, we 
would avoid their more or less serious consequences. 
To treat a case of bronchitis successfully, it is indis- 
pensable that we determine with precision all the ele- 
ments of which it is composed, and then attack the 
more important of them with the greater activity, re- 
membering that there is, as yet, no absolute specific for 
the disease. In order to facilitate the study of this 
subject, acute bronchitis may be divided into two forms, 
the simple and that which is complicated with a dia- 
thetic element. The first is an inflammation of the 
mucous membrane which lines the respiratory passages ; 
the second is the first modified by the apparent or latent 
dyscrasia. Simple bronchitis is purely a local inflam- 






ELEMENTS OF DOSIMETRIC PRACTICE. 139 

mation in the part or organ inflamed, and should be 
checked by def ervescent means. Its effect is not always 
local, however, and the irritation to the nervous system, 
and disturbance to nutrition, may be so decided as to 
nullify, wholly or in part, the action of the deferves- 
cents. In such cases, those agents which have a calma- 
tive effect upon the nervous system may, of themselves, 
be sufficient to check the disease, because they check 
the morbid element, which was originally secondary, 
but has now become the principal one. At the begin- 
ning of attacks of coryza, tracheitis, laryngitis, and 
simple bronchitis, two principal elements are to be an- 
tagonized — the inflammation by aconitine, and the 
cough by morphine. According as one or the other of 
these elements predominates, we should push one or 
the other remedy. If the fever is high and the cough 
is not very troublesome, we should give aconitine every 
quarter of an hour until free diaphoresis is established. 
It may be combined with digitaline if the pulse is rapid. 
If the cough is continual, severe, and fatiguing, it will 
not fail to tend to increase the inflammation if we do 
not take active measures to arrest it. Such means may 
consist in the use of the hydrochlorate or hydrobromate 
of morphine with aconitine, of which two granules may 
be allowed to dissolve in the mouth every quarter of an 
hour until a decided effect is produced. To children 
it is better to give veratrine and codeine for this disease, 
the veratrine being suspended if it will not be tolerated 
by the stomach, and replaced, should the fever con- 
tinue, by very small doses of aconitine, a half, a third, 
or a quarter of a granule being used, according to the 
age of the patient, the intensity of the fever, and the 
result which is obtained. If the first or acute stage is 
over, there is what is called a catarrhal condition, which 
is characterized by a secretion of mucus, and this varies 
greatly as to quantity, viscidity, and facility of excre- 
tion. This secretion almost always excites cough, and 
its intensity is not always proportional to the abun- 



140 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

dance of the secretion. It should always be ascertained 
whether the efforts to expectorate are proportional to 
the necessity of relieving the bronchi of their accumu- 
lations ; for, while it is not desirable that the bronchi 
should be clogged by these accumulations, it is equally 
undesirable that the patient should become exhausted 
by efforts to get rid of them. The cough may reach a 
stage of great exaggeration, either on account of the 
viscosity of the sputa, the bronchial spasm which pre- 
vents their discharge, the want of sufficient muscular 
energy to expel them, or an excessive degree of nervous 
irritability which excites intense reflex movements. To 
counteract the viscidity of the sputa, we should give 
two to three granules of scillitine, or a granule of ar- 
seniate of antimony every two hours, or a granule of 
emetic every four hours. For the spasm a granule of 
sulphate of atropine may be given every three hours, 
or two to three granules of bromide of camphor every 
hour. The antispasmodic, calmative, and mildly stimu- 
lating properties of the last-mentioned drug upon the 
respiratory mucous membrane are very useful in all 
forms of bronchitis, whether acute or chronic. The 
paralysis of the bronchial muscles, which is of infre- 
quent occurrence in acute cases, may be effectively op- 
posed by the hypophosphite of strychnine. Exagger- 
ated irritability may be readily quieted by Gregory's 
salt, narceine, the salts of morphine, iodoform, or cro- 
ton chloral. When, toward the end of the disease, the 
mucous secretion becomes fluid, we should use agents 
which are stimulants to the mucous membrane — for 
example, eight to twelve granules of the benzoate of 
ammonia daily, six to ten granules of sulphide of cal- 
cium, eight to twelve granules of cubebine or piperine. 
The association of morphine and atropine is also very 
useful in the last stages of acute bronchitis, as well as 
in the chronic form of the disease, on account of the 
modifications which it produces in the pulmonary cir- 
culation. Two granules of morphine and one of atro- 



ELEMENTS OF DOSIMETRIC PRACTICE. 



Ml 



pine, or of sulphate of atropine, may be used three or 
four times daily. Emetine and apomorphine are also 
of service in the bronchitis of children, who are very 
susceptible to pulmonary collapse, especially after the 
abuse of antimonials or their congeners. If the bron- 
chitis is under the influence of a diathetic element, its 
treatment should not differ materially from the fore- 
going. The arthritic diathesis is the one which is most 
frequently concerned in rebellious cases of bronchitis ; 
we should use colchicine in cases of such a character, 
associated with aconitine, for their defervescent action ; 
the hydriodate of morphine to quiet the cough, and 
the benzoate of lithia or of soda as a stimulant. The 
scrofulous diathesis requires incitants rather than de- 
fervescents — for example, iodoform, phosphate of iron, 
quassine, strychnine, and juglandine. The tuberculous 
diathesis, which gives rise to the most rebellious forms 
of bronchitis, calls for the repeated use of mild revul- 
sives, together with the vigorous use of defervescents. 
The herpetic diathesis requires the arseniates, or arseni- 
ous acid and veratrine. It is unnecessary to add that 
hygienic precautions should be rigorously enforced. If 
they can not effect a cure, they may ward off exacerba- 
tions which will neutralize the best-arranged plan of treat- 
ment. Hygiene is preventive, therapeutics is curative. 

/Dominant. Inflammatory element 

/Fever . 



X 

i— i 
i— i 

w 

c 
pq 



\ Variant. 



Dominant. 



Febrile intermittence 
Nervous irritation 
Cough . 

Bronchial spasm . 

Viscid secretions . 

\ Fluid expectoration 

/ Arthritic 

I Scrofulous . 
> Tuberculous 

^Herpetic 



Aconitine. 

Aconitine, veratrine, digi- 
taline. 

Hydrobromate of quinine. 

Hydrochlorate of morphine. 

Gregory's salt, narceine. 

Bromide of camphor, sul- 
phate of atropine. 
j Scillitine, emetic, arseniate 
( of antimony. 
\ Benzoate of ammonia, sul- 
( phide of calcium. 

Colchicine, benzoate of 
lithia. 

Iodoform, iron, quassine, 
strychnine. 

Iodoform, revulsives. 

Arseniates of quinine and 
soda, arsenious acid, vera- 
trine. 



142 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Capillary Bronchitis.— Capillary bronchitis is one 
of the gravest diseases that attacks children. Though 
this may be considered a catarrhal affection, the pri- 
mary lesion is superseded by secondary ones which 
are caused by it. The feeble contractile power of the 
bronchi becomes the predominant morbid factor, which 
must be taken into account in treating the disease, for 
it is the principal cause of its mortality. Therefore, 
the neurosthenic agents should be used in preference 
to the anti-catarrhal ; brucine or strychnine will, there- 
fore, become the dominant medicament, as long as the 
capillary obstruction lasts, in doses of one granule 
every hour for children over two years of age. After 
the permeability of the respiratory tract has been re- 
stored, we can give two granules of the sulphide of cal- 
cium every two hours to overcome the catarrhal secre- 
tion. Helenine will till the same indication, one granule 
being given every three hours. Though the tempera- 
ture in this disease is not apt to be very high, never- 
theless it tends to increase the dyspnoea and the vital 
prostration. It may be treated with veratrine, the 
mildly emetic and expectorant powers of which are 
quite appropriate for diseases of the respiratory ap- 
paratus in children. One to two granules in solution 
may be given every hour until vomiting or deferves- 
cence is accomplished. After having produced a mod- 
eration of the fever, we should give the hydroferro- 
cyanate of quinine to overcome the intermittent char- 
acter of the fever, which is more or less pronounced in 
all diseases of a catarrhal character. One to three 
granules may be given every two hours. A dry and 
harassing cough results from the adhesion of the sputa 
to the mucous membrane. For this condition expec- 
torants are indicated, particularly the benzoates of soda 
and ammonia and scillitine. Two granules may be 
given every two hours. But, if the spells of coughing 
are very frequent and fatiguing, several doses of codeine 
should be given, in quantity one to three granules every 



ELEMENTS OF DOSIMETRIC PRACTICE. 143 

hour, until a calmative effect is produced. The dysp- 
noea will continue as long as the obstruction in the 
bronchial tubes exists. In cases in which suffocation 
seems imminent, an emetic must be given to effect the 
expulsion of the collections in the tubes. Three gran- 
ules of emetine in solution may be used for this pur- 
pose every ten minutes, until an effect is produced. A 
beneficial result may thus be rapidly produced, but we 
must not be deceived by it, for it may be only for the 
moment. The improvement with respect to the dysp- 
noea may be compensated by the greatest depression 
of the physical forces— that is, the patient may rapidly 
get worse ; unless the indication is very urgent, there- 
fore, we must refrain from using violent emetics, and 
instead use apomorphine in doses of two granules every 
two hours. In addition to its incisive properties (in 
the matter of separating the deposits of mucus), it is 
also a tonic to the respiratory apparatus, and thus 
comes to the relief of the dominant. The antimonials 
(kermes, emetic, and arseniate of antimony) should be 
held in reserve for the purely catarrhal period. They 
are too depressing in their action to be used while the 
pulmonary alveoli are threatened with collapse. Small 
flying blisters may be of service to stimulate both the 
local and general vitality, and to overcome pulmonary 
oedema, which threatens to complicate the situation ; 
they should not be so large as to confine the field of 
respiration, nor restrain thoracic dilatation. The effect 
of vesicants in this disease is dynamic rather than 
physical, and therefore small ones frequently repeated 
are preferable to large ones, which can not be renewed 
very often. The convalescent stage should be watched 
with great care. Relapses occur very readily, and are 
the more frequent as the patient is more prostrated. 
We should not neglect to use all possible hygienic 
means of precaution in helping the patient through 
this stage of reparation. Two granules of quassine 
may be given with each meal to stimulate digestive 



141 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

action, and two granules of the arseniate or sulphate 
of strychnine, two to four times daily, to increase the 
vital resistance. 



JhGQ 


1 Dominant. 


Vaso-motor paralysis 


Brucine. 


%&t 


/Catarrhal secretion . 


Sulphide of calcium. 




Fever 


j Hydroferrocyanate of 
\ veratrine. 




» Variant. / Cough . . 


Benzoates, codeine. 




Dyspnoea . 


Apomorphine. 


og 




Asphyxia . 


Emetine, veratrine. 






\ Convalescence . 


Quassine, strychnine. 



quinine, 



Bronchorrhagia.— See Broncho-pulmonary Hrem- 
orrhages (under Hcemorrhages). 

Bubo.— See Syphilis. 

Cancer of the Stomach. — Though this disease is 
incurable, the physician should not altogether abandon 
the patient to his fate. Not only should he use palli- 
ative means to soothe the pain and prolong the life of 
the patient, but he should seek for a curative treatment 
if only by eliminating in succession those medical sub- 
stances which might by chance be useful. It is not 
absolutely essential that the treatment of incurable dis- 
eases should be forced in the expectation of producing 
positive results, for even negative results have their 
value, and by the systematic elimination of those means 
which have been tried and found unsuccessful the 
proper agent may some day appear, if it exists. Hy- 
drastine has been recently tried by the author in doses 
of twelve to fifteen granules daily, divided into three 
equal parts. The conditions of experimentation have 
been varied, and in all cases this substance appears to 
delay the fatal issue. The dose may be increased with- 
out danger to the patient, and the subject is worthy 
of further investigation. Arseniate of soda, combined 
with iodoform by modifying the nutrition, may also be 
used with advantage. The principal medication must, 
therefore, be symptomatic in character. The pain of 
the disease may be relieved by cicutine, the dosage 
being varied in accordance with the severity of the 



ELEMENTS OF DOSIMETRIC PRACTICE. 145 

case. If the pain is intense, two granules may be 
given every half-hour ; if less severe, three granules 
may be given before each meal. The vomiting may be 
relieved with one granule of valerianate of atropine, 
combined with three of the hydrobromate of morphine, 
if the vomiting is the result of irritation ; if, on the 
other hand, it is due to a catarrhal condition of the 
stomach, three granules of quassine may be given be- 
fore each meal with Sedlitz Chanteaud. Difficulty in 
digestion may be diminished by using three granules 
of pepsin with each meal. Diarrhoea, resulting from 
imperfectly digested proteid elements of food, and from 
the septic products of the ulcerating process, should be 
treated with the salicylates or iodoform, two granules 
of each three or four times daily. The anaemia which 
results from the combined effect of the cancerous dis- 
ease and dyspepsia may be treated with the salicylate 
of iron, two or three granules being given with each 
meal. The hectic fever, which tends greatly to weaken 
the patient and to shorten his life, may be treated with 
ten granules of the salicylate of quinine three or four 
times daily. Dropsy in this disease indicates that the 
fatal end is near. When it supervenes, we should give 
sulphate of strychnine, which, though it may not cure 
it, will at least stimulate the forces of the organism and 
retard the effusion of serum as the degeneration pro- 
gresses. The most appropriate form of diet will be the 
milk-diet ; not only because it will diminish the suf- 
ferings of the patient, but because it will also have a 
curative action in those cases which have been wrongly 
diagnosticated as cancer. After the cancerous tumor 
has produced stenosis either at the cardiac or the 
pyloric end of the stomach, it will be useless to insist 
upon attempting to feed the patient by the stomach. 
Enemata of peptonized food will sustain the patient 
better, and will not cause the pain which is produced 
if food is taken into the stomach. 



10 



146 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

s 

^ . /Dominant. Cancerous dystrophy . . Hydrastine. 

f*W| /Pain Cicutine. 

0%\ Vomiting . . Morphine, atropine. 

£3^ I Variant \ Anaemia Salicylate of iron. 

HO I Diarrhoea Salicylates, iodoform. 

p E-j I Fever Salicylate of quinine. 

5 V Dropsy Sulphate of strychnine. 

Q 

Cardiectasis (Asystole, Dilatation of the Heart). 
— The distention of cavities which are bounded by mus- 
cular walls always produces a more or less accentuated 
condition of paresis, which constantly tends to aggra- 
vation with the correlative exaggeration of this disten- 
tion. Obstacles, of whatever character, to the pro- 
pulsion of the blood by the cardiac systole, lead to an 
accumulation of blood in the heart- cavities, which thus 
become dilated, and the walls become thinned. The 
contractile force becomes less energetic at every point, 
its impulse more feeble, and the evacuation of the cavi- 
ties more and more incomplete. As long as this diffi- 
culty is not compensated by hypertrophy, the vicious 
circle continues, and the functional perturbations in- 
crease in gravity. Cardiectasis may also arise from 
primary lesions of the heart-muscle, which give rise 
to the same train of consequences. If hypertrophy 
occurs, it delays, but does not obviate, the fatal conse- 
quences of the failure of mechanical equilibrium. 

The fundamental lesion in cardiectasis consists in a 
weakness in the contractile force of the heart. The use 
of ergotine and sulphate of strychnine, two of the most 
reliable agents for preserving and increasing the mus- 
cular force, will, therefore, constitute the dominant. 
The doses will vary with the pathological effect of the 
primary lesions. If the perturbations are scarcely per- 
ceptible to the patient, three granules of each, three to 
five times daily, will be sufficient ; but, if asystole be- 
comes imminent, four granules of each must be given 
every half -hour until a positive result is obtained. 
(Edema in these cases is due to venous stasis, and con- 
sequently it is only when the heart regains its energy 



ELEMENTS OF DOSIMETRIC PRACTICE. 147 

that the oedema disappears. For this condition we may- 
give two granules of the hypophosphite of strychnine 
three to five times daily, together with two teaspoonfuls 
of the Sedlitz Chanteaud daily for a diuretic and laxa- 
tive. Weakness and irregularity of the pulse call for 
the use of digitaline ; as soon, however, as the physio- 
logical effect of this drug has been accomplished, we 
should associate with it the arseniate of strychnine. 
Vertigo, which results from cerebral ischemia, may be 
relieved by the use of caffeine or by Gregory's salt, two 
granules being given every half-hour until the desired 
effect is obtained. Lipothymia calls for the stimulating 
action of phosphoric acid, two granules every ten min- 
utes until relief is obtained. Pulmonary congestion in 
this disease is sometimes accompanied by rupture of 
the vessels. This pneumorrhagia should be treated 
with three granules of ergotine every quarter of an 
hour, and with one granule of digitaline every half- 
hour if the pulse is weak and irregular. Congestion 
will also be benefited by two granules of the sulphate 
of strychnine every half -hoar or hour. If the cough 
and dyspnoea do not yield to the dominant, one may 
give three granules of the hydrobromate of morphine 
every half-hour. Palpitations are the evidence of the 
unsuccessful efforts which the heart is making to relieve 
itself of the excess of its contents. The resulting atony 
of the cardiac movements may be regulated by two 
granules each, of arseniate of strychnine and digitaline, 
two to three times daily. Cardiac cachexia is a symp- 
tom of grave import, for it shows that it is no longer 
the heart alone whose energy is depressed, but that the 
entire organism is compromised by the insufficiency of 
the pulmonary circulation, which causes difficulty in 
the passage of the blood, and a condition which may 
not be easily modified. The general nutrition in these 
cases is much debilitated, which calls for the use of 
agents which will modify the blood and the general 
innervation. The arseniates of iron, strychnine, and 



148 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



antimony may be combined in this attempt to prolong 
life. If the dilatation is not excessive, life may be pro- 
longed and asystole delayed by the use of cardiac tonics 
and a well-regulated hygiene which should prevent any 
violent disturbance of the equilibrium of the forces, 
which at such a time is so delicately poised. This end 
may be obtained by the use of two or three granules of 
strychnine and of digitaline every evening, and contin- 
ued for a long time. The digitaline may be replaced 
from time to time by caffeine or guaranine, three to 
five granules every evening. The daily use of Sedlitz, 
physical and moral repose, regularity as to the gastro- 
intestinal functions, abstinence from coitus and from 
all stimulants, will be found useful in delaying the ulti- 
mately fatal issue of cardiectasis. 



m 
m 
< 

Q 



Dominant. 



Variant. 



Diminution of contrac- 
tility . 
/ (Edema . 
Weakness of the pulse 
Vertigo . 
Lipothymia 
Pneumorrhagia 

Congestion 

Cough, dyspnoea 

Palpitations . 

V Cardiac cachexia 



\ Ergotine, strychnine. 



Hypophosphite of strychnine. 

Digitaline. 

Caffeine, Gregory's salt. 

Phosphoric acid. 

Ergotine. 
j Sulphate of strychnine, digi- 
( taline. 

Hydrochlorate of morphine. 
j Arseniate of strychnine, digi- 
\ taline. 

\ Arseniates of iron and strych- 
\ nine. 

Catalepsy.— This curious disease furnishes one of 
the most remarkable examples of dynamic affections. 
Its sudden appearance and disappearance, the profound 
disturbance which it causes in the most important func- 
tions, the latter showing nothing abnormal after the 
attack has passed away, all seem to demonstrate that 
this disease consists merely in a transposition of forces 
which have left the brain and accumulated in the spinal 
cord. It furnishes the clearest confirmation of the the- 
ory of inhibition and dynamic influence — inhibition on 
the part of the cerebral functions ; dynamic influence 
with reference to muscular tonicity. The brain thinks 
less, the will is abolished, but, as a compensation, the 



ELEMENTS OF DOSIMETRIC PRACTICE. 149 

function which determines stability becomes exagger- 
ated. Catalepsy, therefore, consists of two principal 
dynamic lesions — inertia of the brain and spasm of the 
cord. Treatment must, therefore, be regulated in ac- 
cordance with this morbid duality, and the pathogene- 
sis of the condition justifies that form of treatment 
which associates drugs which have more or less an- 
tagonistic features as to their physiological action. In 
this, as in all diseases in which there is a want of vital 
equilibrium, we must use hyoscyamine and strychnine 
combined. Each drug directs its action to a particular 
perturbation, and the disease, thus combated in its two 
principal manifestations, will yield with more certainty 
and promptness than by any other method. In the 
intervals between the attacks we should, therefore, give 
one granule of each drug three or four times daily. 
During the attack there is little that can be done ex- 
cept to seek to re-establish the equilibrium by acting 
upon the functions which still remain unaffected. One 
method which is worthy of trial consists in the sub- 
cutaneous injection of apomorphine, in doses of one 
hundredth of a grain. Injections of atropine may also 
be tried. Habitual masturbation, which is one of the 
most frequent causes of catalepsy, may be treated with 
three granules of the bromide of camphor morning and 
evening. AnaBmia and debility are predisposing causes 
to this condition, and may be treated with two granules 
each of the arseniate and valerianate of iron at each 
meal. The nervous irritability, which is especially 
noticeable among those who suffer with hysteria and 
other neuropathies, may be treated with three granules 
of the phosphide or valerianate of zinc three times daily. 
The element of periodicity, which is often a prominent 
one in this disease, will call for the use of three to five 
granules of the valerianate of zinc three times daily. 
This treatment must be kept up for a long period, as 
it is evidently impossible to restore the nervous system 
to its normal condition in any brief period. 



150 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

g /Dominant. Want of nervous equilibrium { H ^?^£ e . arSeniato 

Put /Masturbation. . . . Bromide of camphor. 

W *„.»„„•„ ( Arseniate and valerian- 

^ Ivariant. Anaemia \ ate of iron. 

% Instability of the nervous sys- | Phosphide of zinCt 

\Periodicity .... Valerianate of quinine. 



o 






Catarrh, Epidemic (Grippe). — This disease, which 
was at one time as deadly as the cholera, appears to 
be due to the development of parasites or miasmatic in- 
fluences, which are manifested only in connection with 
certain variations of the atmosphere. The symptoms 
indicate a toxic condition, and the course of the fever 
shows that the morbific influence has more or less of 
an analogy with paludal miasm. The excellent results 
which have been obtained by quinine confirm this 
theory, and indicate the alkaloid of cinchona as the 
true remedy for the dominant. We may use with ad- 
vantage the hydroferrocyanate of quinine, the anti- 
periodic action of which has been well proved, and 
which will also soothe the accompanying irritation of 
the respiratory passages better than the derivatives of 
opium. The headache, often intolerable, which accom- 
panies the invasion of the disease, and which, in con- 
nection with redness of the conjunctiva, photophobia, 
and ringing in the ear, shows that there is active con- 
gestion within the cranium, may be readily controlled 
by aconitine, which will also moderate the febrile con- 
dition and the excitement of the circulation. One gran- 
ule may be given every quarter of an hour, or less fre- 
quently, as the case may demand. 

In other cases the most pronounced effects of this 
disease are manifested in connection with the digestive 
apparatus, the patient being troubled with nausea, 
vomiting, diarrhoea, etc. For this variety we should 
give Sedlitz Chanteaud to produce a prompt elimination 
of the exciting causes of the disease, and to free the 
intestine of the contents which are undergoing fer- 
mentation. The vomiting and diarrhcea may be checked 



ELEMENTS OF DOSIMETRIC PRACTICE. 151 

by the use of two to three grannies of hydrochlorate of 
morphine every honr, or of brncine in the same quan- 
tity if the morphine can not be tolerated. The tho- 
racic variety of this disease presents the form of an 
acute bronchitis, though the accompanying cough is of 
a drier character than obtains in simple bronchitis. 
The sulphide of calcium is indicated as a means of 
treatment, three granules being required every hour, 
associated with a like quantity of codeine, until a 
soothing effect has been obtained. The accompanying 
broncho-pulmonary congestion demands a granule of 
digitaline every hour until the cardiac action is regu- 
lated. The prostration which attends or follows the 
disease should be met by the arseniate of strychnine. 
With old and very feeble persons we should remember 
the difficulty in obtaining complete resolution of the 
inflammation of the respiratory passage, and anticipate 
such an accident by the use of hypophosphite of strych- 
nine. One to two granules of this may be given every 
two hours until all danger is past. Apomorphine 
may also be of service at this juncture as a tonic to 
the lungs, and to facilitate expectoration, two granules 
being given every two hours. The anorexia, which 
often retards convalescence after the disease has dis- 
appeared, may be treated with one granule of quassine 
and one of arseniate of soda four to six times daily. 
Whatever the medicament which is imposed by the 
variant, we should always associate with it the domi- 
nant until the beginning of convalescence. It is only 
by this plan that we shall be enabled to obtain positive 
profit from the symptomatic method of medication. 
All the morbid elements in this disease must be care- 
fully recognized and treated, but the paludal element 
requires especial attention. This is essentially the 
characteristic of the disease ; therefore, if we omit the 
use of quinine in our plan of treatment, all the other 
medicaments may prove futile. In severe and acute 
cases, in which it is desirable to have an uncomplicated 



152 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

plan of treatment, the accessory indications must be 
neglected, and all our attention be paid to the funda- 
mental one. In some cases we will be compelled to 
give the hydroferrocyanate of quinine every quarter 
of an hour, perhaps for a long time, and it may be to 
the exclusion of all other remedies. The great diffi- 
culty is not so much in recognizing the indications, and 
the proper remedies for them, as in making a selection 
of the morbid elements which require especial attention. 



2td /Dominant. Miasmatic infection . Hydroferrocyanate of quinine. 
/Cephalalgia . . Aconitine. 
Nausea and vomiting Sedlitz Chanteaud, brucine. 
Diarrhoea ^ Sedlitz Chanteaud, hydrochlo- 



w o I Variant, 



( rate of morphine. 
Cough . . . Sulphide of calcium, codeine. 

Bl r^J ; P " lm ° nary Valine. 



congestion 

Prostration . . Arseniate of strychnine. 
\Anorexia . . . Quassine, arseniate of soda. 



Chancre {Infecting or Hard). — See under Syphilis. 

Chancre {Simple or Soft).— See under Syphilis. 

Cholera Morbus. — The value of science is properly 
understood only at those critical periods when either 
the individual or the community demands a remedy, 
effective in its results and rapid in its action, for the 
plague which threatens its very existence. Then the 
assistance of medicine and hygiene is earnestly be- 
sought, and their advice is willingly heeded ; then 
alone does the state deplore the fact that the public 
sanitary service is so poorly organized and provided 
for. Until such a calamity either threatens or actually 
is present, and the existence and fortune of both gov- 
erned and governors are in danger, means for the de- 
velopment and perfection of scientific ends are doled 
out from the public purse only in the most niggardly 
manner. Funds enough are always available for monu- 
ments and theatres, for pomp and display, but to aid 
learning, to endow schools, to stimulate a love for scien- 
tific research by honorable prizes and emulation for 
grand discoveries, not a cent. 



ELEMENTS OF DOSIMETRIC PRACTICE. 153 

When the pestilence or the cholera, leaving the 
marshy shores of the Ganges, glides across the Indies, 
stretching one arm toward Turkey and the other toward 
Egypt, and then reaches Western Europe ; when it 
penetrates its cities, crowded with marble palaces as 
well as decaying ruins, making them the centers for its 
devastating excursions, then kings hide themselves, and 
the people fly in confusion, like madmen at a conflaga- 
tion, ready to destroy whatever obstructs their path. 
Then the academies convene and the doctors discuss. 
The rulers consult this oracle, and the response is one 
which excites the derision of the world. These learned 
men guard against the discovery of a remedy; they 
hesitate to recommend proper means for the prevention 
of the plague ; instead, they present us with a microbe, 
and give it a name which is soon familiar to all. In 
olden times the people demanded panem et circenses 
(food and public games) ; now they are satisfied with 
an empty process of reasoning, or a bon mot carelessly 
repeated. At such a time one sees the almost impotent 
condition of science, and then, when controlled by fear, 
we are promised by the powers that be those reforms 
which prudence long ago suggested. But this is only 
the illusion of the moment, for, when the public peril 
has disappeared, hygiene is again disregarded, thera- 
peutics is unheeded, and science is more completely 
ignored than ever. What is the true cause of cholera % * 

* Dr. Besmer, well known on account of his epidemiological investi- 
gations, made the following declaration to the Academy of Medicine of 
Paris at the session of July 29, 1884: "It seems that the discoveries ot 
clinical medicine and of chemistry have given us nothing that is certain ; 
we can not yet distinguish during life, nor after death, a case of ordi- 
nary cholera from a case of Asiatic cholera ; we are still ignorant of the 
nature of the agent which produces it, its exact method of introduction 
into the system, the portion of the organism which is first affected, the 
method and the time in which evolution of the morbid germ occurs in 
individuals and in objects — in a word, the differences of opinion upon 
these points are more accentuated than ever." (" Gaz. heb. de Med. 
et de Chir.," August 1, 1884, p. 517.) 



154 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

The positive notion in regard to the efficient cause 
or causes of diseases is, without any doubt, the basis of 
pathogenesis, prophylaxis, and therapeutics. It is for 
that reason that investigators search so earnestly in 
cadavers, in excretions, and in etiological factors, for 
the cause of material lesions and functional disturb- 
ances. No one doubts at the present time that cholera 
is a zymotic affection, a disease produced by the intol- 
erance of the organism for parasites, probably of vege- 
table origin, which attack it and disturb its functions, 
whether from the elements which they take away from 
it, or the toxic elements of secretion or decomposition 
which they give up to it (on the latter hypothesis they 
are comparable to the cadaveric ptomaines or alkaloids), 
or from the irritation which they cause, as foreign 
bodies, in the living tissues.* This explanation, though 
hypothetical, is the only one which harmonizes all the 
facts and circumstances in overwhelming epidemics, 
such as attend the presence of cholera. Cholera, theo, 
is due to a microbe which is endemic in India, is propa- 
gated through great distances, and is transported by 

* In the lower orders of vegetables, as Blainville showed in 1882, the 
ternary elements of cellulose exist in greater quantity than the azotized 
elements. Now, as all varieties of cellulose resist the action of ammonia, 
and as microbes are not altered by it in their morphological characters, 
differing in this respect from infusoria, it follows that they should be 
classified among the vegetables. Besides, acetic acid blanches all animal 
tissues, but microbes resist its action. Finally, ha3matoxylon colors bac- 
teria, which would not be the case if they were microzoa. The straight, 
elongated form which many bacteria present, is also foreign to animal 
existences. The motion by which they are animated is not an argument 
against this opinion, for they only execute a motion of translation by 
one or the other extremity. If microbes are vegetables they can not 
live without water; dryness ought to destroy them, and moisture ought 
to favor their development. The medium in which the microbes are 
found may not be exactly the same as that which their sporules or germs 
require, which unquestionably is a moist one. The atmosphere does 
not transport microbes, but it carries and disperses their innumerable 
germs. The microbes are the agents of contagion ; the sporules of in- 
fection. 



ELEMENTS OF DOSIMETRIC PRACTICE. 155 

individuals, by objects, or by the atmosphere alone. 
The transportation of the germs of cholera by the at- 
mosphere is proved by the influence of all epidemics at 
a great distance from the foci of infection, by the effects 
which are x>roduced in all the individuals in the con- 
taminated localities, by the want of any other expla- 
nation for certain well-established facts in which the 
means of contagion can not be discovered, and by the 
discovery of germs and other microbes which float in 
the atmosphere. It has been observed that whenever 
Europe has been visited by an epidemic of cholera, the 
epidemic has always been preceded by an affection of 
the digestive tract, which has an entirely different clin- 
ical physiognomy from that which is usually presented 
by such troubles ; that whenever the epidemic has be- 
come established at a given point there is evident, not 
only in contiguous localities, but in those which are 
remote, the influence of a morbific agent which produces 
sporadic cholera, cholerine, and other diseases which 
are but the shadow of the epidemic itself ; and this in 
spite of great differences in climate and atmospheric 
condition. All these diseases have a resemblance, more 
or less definite, to true cholera. In those localities in 
which the disease (cholera) appears in all its intensity, 
though all the inhabitants may not be actually attacked, 
they all are influenced to a greater or less extent by the 
disease. Even those who are, to all appearances, in the 
best of health, show a diminution in the rate of the 
heart's action. This fact is now explained with more 
of clearness and reason than formerly, by the presence 
of microbes in the atmosphere. If, therefore, it is 
proved that there are germs in suspension in the atmos- 
phere which circulates around the foci of infection, we 
must admit that aerial currents transport them from 
great distances, disseminate them, dilute and attenuate 
them more and more as the distance from their source 
increases. From the foregoing it follows that a single 
microbe may not, necessarily, suffice to produce the 



156 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

disease. The effects of that agency, like those of all 
other agencies, depend on the one hand upon the 
energy and number of the elements (microbes), and on 
the other upon the receptivity of the patient. The 
question is simply one of dose and of tolerance. In 
the centers of infection, where the germs are very nu- 
merous and very active, many individuals are attacked, 
and the attacks are overwhelming, severe, or mild, ac- 
cording to the resultant of the two factors. In a circle 
of territory with a radius of greater or less extent we 
will find, beyond the cholera zone, one in which chol- 
erine and sporadic cholera prevail ; beyond this, one in 
which indigestion and diarrhoea are prevalent ; at a 
still greater distance, and perhaps at a great altitude, 
one in which the microbes are relatively infrequent, and 
cause no noticeable effect upon living organisms. Mi- 
croscopic analysis of the microbes and germs in suspen- 
sion in the atmosphere, under ordinary conditions, has 
as yet failed to explain their differential characteristics. 
The number of such microbes and germs increases and 
diminishes with their distance from centers of infection 
and the conditions of ventilation. The same must be 
true as regards cholera, and, as a matter of fact, who 
are the individuals who are the most susceptible to 
cholera? They are those who dwell where the air is 
most likely to be infected with cholera-germs. When 
are the attacks most likely to occur? In the night, 
when the chilled and condensed air is most abundantly 
charged with microbes. In what localities do we find 
the greatest number of cases % In low and damp coun- 
tries, where ventilation is less active, the air more dense 
on account of the atmospheric pressure, and, therefore, 
the germs more abundant. Distance has an influence 
upon microbes, not only with reference to their number 
and their dissemination, but also with reference to their 
quality. Such parasites and their germs, removed from 
their native center, can not find in the climates of Eu- 
rope an assured existence. The conditions of their 



ELEMENTS OF DOSIMETRIC PRACTICE. 157 

multiplication must, of necessity, be changed ; hence, 
the longer the period of time between their birth and 
their fixation in the suitable medium, the more pre- 
carious their functions of nutrition and reproduction. 
Differences of medium, upon organisms so simple and 
rudimentary, must act rapidly upon their vital energy, 
modify their malignity, attenuate their virulence, and 
destroy their pestilential action. It rarely occurs that 
they can be transported alive, by atmospheric currents, 
from their home in the Indies to Europe ; but ships are 
always in readiness as vehicles for their industrious 
emigration, with their atmosphere below decks abound- 
ing in moisture and deficient in ventilation. This fur- 
nishes us with an important hint for the use of pre- 
ventive and preservative measures. The work of the 
student of science, on the other hand, is to discover, to 
recognize, and to explain the causative microbe, and to 
investigate the conditions of its existence — its nutri- 
tion and its proliferation. With this end in view, the 
fluids, the tissues, and the secretions of the body are 
examined with the microscope, to discover elements 
which do not normally belong there. If any are found 
they are at once announced as the source of all the 
trouble which the disease has caused. In spite of cer- 
tain obscure conditions, it is quite evident that the 
comma-bacillus is really the specific cause of cholera. 
If it is true, as Koch says, that the comma-bacillus dies 
in acid solutions, but lives in alkaline and neutral ones, 
this fact can not be insignificant in adopting a curative 
and counteracting plan of treatment of cholera. On the 
other hand, this fact would explain how intemperance 
and f au] ts as to regimen would act in reference to the 
appearance of cholera. In fact, any irritation whatso- 
ever will increase the alkaline intestinal secretion and 
diminish the acid gastric one. Thus it might also be 
explained why attacks are more frequent at night, for 
we know that, with herbivores and omnivores, the in- 
testinal liquids are alkaline during digestion, while, on 



158 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

the contrary, those who are most like the carnivores, 
whose bile is acid during digestion, and who subsist 
mainly upon nitrogenous food, are most likely to be 
exempt from cholera — that is to say, the rich, who are 
carnivores to a greater extent than the poor, are less 
apt to be attacked by cholera. Hence it will be proper, 
during epidemics of cholera, to partake freely of acidu- 
lated drinks, especially those which contain the mineral 
acids — sulphuric, nitric, and hydrochloric. Such means 
are much more available to the poor than any particu- 
lar form of diet, especially one composed principally 
of animal food. It will now be proper to see whether 
there is any sign which will enable us to discover the 
nature of the disease ; in other words, to ascertain in 
what part of the body the microbe is located after it 
has entered it, and what are the primary lesions which 
it causes. We must first find out whether the microbe 
infests the entire organism or is limited to the gastro- 
intestinal canal. According to the theory of Paquet, 
the parasites, having entered by the respiratory pas- 
sages as well as by the digestive ones, encompass the 
entire organism, multiply in all the fluids, attack the 
nervous centers which preside over the nutrition of the 
liver and intestines, and the vaso-motor centers of the 
bulbo-spinal system. Other writers admit only a mul- 
tiplication in the intestine, and consider that all other 
symptoms are secondary, and derived from the intesti- 
nal lesions. The theory of Strauss, that the morbific 
agent of cholera is in the blood, has never been con- 
firmed. Thus far the microbes have only been found 
in the intestinal fluids, and, if the disease continues for 
some time, in the superficial layers of its inner tunic. 
Their absence from the blood, the negative or uncertain 
results which have followed inoculations, would seem 
to indicate that they could proliferate and be developed 
only in the fluid which is secreted by the intestinal 
glands. In those cases which are overwhelming in 
their effects and rapid in their termination there are no 






ELEMENTS OF DOSIMETRIC PRACTICE. 159 

perceptible lesions ; it is only in cases which have lasted 
a long time that one finds proliferations, hypertrophies, 
and evidences of vascular irritation, lesions which are 
evidently secondary, and evidently caused by the dis- 
ease and not by the morbigenous agent. It would, 
therefore, appear that the lesions are primarily dy- 
namic. The microbe, having been introduced into the 
intestine, produces, at the ends of the nerves which 
radiate from the intestine, a modification which de- 
stroys their vitality, paralyzes their action, and thus 
disturbs the entire vital equilibrium which is necessary 
to the perfect performance of the functions. This modi- 
fication may be due to the irritation caused by contact, 
to the toxic action of the excretions of the microbe, or 
to its appropriation of vital energies and nutritive ele- 
ments. From this primary dynamic depression of the 
great sympathetic the entire series of other symptoms 
follows, the order of which is satisfactorily explained 
by the principles of pathological physiology. Thus 
the two opinions may be harmonized (concerning a pos- 
sible intestinal or a neural origin), for the lesion which 
begins in the intestines is immediately communicated 
to the entire economy, with the rapidity which charac- 
terizes neural disturbances. This opinion best explains 
all the facts ; besides, it is founded upon incontestable 
principles of experimental physiology. In order to 
thoroughly understand the pathogenesis of all the cases, 
we must not forget that every disease depends upon two 
factors, the agent and the patient. According to the 
quantity and quality of the morbific cause on the one 
hand, and the impressionability — that is, the organo- 
vital conditions of the individual attacked — on the 
other, we shall have an attack which will be mild, se- 
vere, or overwhelming; a case of mucous, serous, or 
asphyctic cholera. With many microbes and great re- 
sisting power of the nervous system, an individual may 
remain free from the disease ; with few microbes and 
feeble resisting power, another may succumb. Physio- 



160 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

logical experimentation, according to Armand Moreau, 
has thrown mnch light npon this question. He oper- 
ated by tying the intestine at two points, and then cut 
the nerves which were distributed in this segment. The 
next day he found the isolated portion of intestine en- 
tirely filled with intestinal secretion. On another occa- 
sion, leaving the nerves untouched, the following day 
there was no fluid in the intestine ; its walls were de- 
pressed and almost dry, like those of a fasting animal.* 
This experiment proves the influence of the nerves upon 
the intestinal secretions. When their functions are 
regularly performed, the intestine remains dry ; but 
when they are paralyzed or destroyed, the intestine 
quickly becomes filled with enteric transudation. To 
this experiment may be added the results of every-day 
observation. We know the depressing effect of certain 
moral disturbances upon the intestinal secretions, espe- 
cially the effect of fear. The frightened animal trem- 
bles, the skin becomes pale and cold, the intestinal 
secretion increases, there is a serous diarrhoea, and the 
sphincters relax and allow the urine and f seces to escape. 
This morbid condition, more or less pronounced, is 
known by the name of colic, a term which is mainly 
used to designate its principal localization. Far from 
being a metaphor, this is the designation of a morbid 
physical condition which has its seat in the abdomen. 
All these symptoms have their origin in a depressing 
moral impression which produces a reflex paralysis of 
the intestinal vaso-motor nerves. Add to the effect of 
fear the influence of the microbes, which increases the 
cause and aggravates the dynamic lesion, the microbes 
occupying the entire extent of the intestine, and multi- 
plying in a few hours, with frightful rapidity, when 
they find conditions which are favorable to their cult- 
ure ; and there will be little difficulty in understanding 
how the attack of Asiatic cholera is started and devel- 
oped. Dartier and Morat have observed, in the course 

* Budge, "Compendium of Human Physiology,"- p. 210, Paris, 1874. 



ELEMENTS OF DOSIMETRIC PRACTICE. 1G1 

of numerous experiments,* that the intestinal vaso- 
constriction or paralysis of the great sympathetic coin- 
cides with the vaso-constriction of the cutaneous and 
bucco-facial regions. Thus is explained in a satisfactory 
manner the coincidence and succession of the symp- 
toms, diarrhoea, algidity, dryness of the tongue, cardiac 
disturbances, and, as phenomena of dynamic character, 
the spasms of the muscles animated by the lumbar 
segment of the cord and then by the upper segments. 
As all this takes place in connection with the motor- 
nutrient innervation, we can understand how the related 
functions may remain intact. The etiological condi- 
tions of the disease harmonize perfectly with this hy- 
pothesis. In all the epidemics it has been observed 
how forcibly fear influences the appearance and the 
gravity of the attack. All authors agree in recommend- 
ing calmness and courage as the most efficient prevent- 
ive means. The venerable Burggraeve, who has already 
had experience in five epidemics of cholera, concludes, 
after giving different rules of action, "It is fear, above 
all things, which must be overcome." We have already 
seen how the effects of fear, which are explicable only 
as a temporary paralysis of the sympathetic, resemble 
cholera in miniature. Colds also predispose greatly to 
attacks of cholera, and we have already seen that the 
cutaneous vaso-constriction coincides with the intestinal 
vaso dilatation. Old people, sick people, and convales- 
cents, whose nervous force has been lowered, are also 
very susceptible to diseases like this, and with them it 
is very apt to be fatal. The same may be said of those 
who are much emaciated, and those who are badly 
nourished. The majority of the fulminant cases occur 
in those who are subjects of relapse. It is natural 
that the sympathetic, already depressed by one attack, 
should less readily withstand a second one. It would 
appear, then, that of the two morbid factors, the agent 
and the predisposition, the latter is the more to be 

* See Paquet, " The Preventive Treatment of Cholera," Paris, 1883. 
11 



162 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

feared. There need be no fear of exaggeration if we 
counsel the use of all measures which are capable of 
preserving the health of mind and body. This would 
always be the best way to escape the attacks of a pesti- 
lence. Having thus indicated the primary conditions 
of the disease, let us now see how it is established. 
The germs which are found in the epidemic centers in 
great numbers, either suspended in the atmosphere or 
deposited in the food which is ingested, penetrate 
through the mouth, the respiratory apparatus, or the 
digestive canal. * In the respiratory apparatus, where 
they do not find a medium favorable for their germina- 
tion, they remain inert. Those germs which penetrate 
into the stomach find there an acid medium which de- 
stroys them. The reaction of the gastric juice, under 
pathological conditions, may not be acid, however, in 
which case more or fewer of the microbes would reach 
the intestines, where they would find a more favorable 
medium. They would then begin to vegetate, and ex- 
cite diarrhoea, diminution of the pulse, etc., until they 
were completely destroyed by surrounding conditions 
unfavorable to their development ; or at least until the 
enteric secretion, produced either by intestinal irrita- 
tion or by depression of a moral character, no longer 
renders their proliferation easy, on account of the 
chemical constitution and physical condition of the 
medium. This enteric secretion in question may also 
be the result of modification of the regime, of drilling 
of the surface, etc. In fact, we know to what an extent 
almost inappreciable differences in the chemical consti- 
tution of the fluid of Raulin influence the development 

* It appears to the author that sufficient attention has not been paid 
to the fact that microbes may enter by the anus. The extreme fre- 
quency of attacks which occur in infected latrines, the rapidity with 
which the disease is propagated when it is carried by means of human 
dejecta, as is observed in the case of armies on the march, lead him to 
think that this mode of penetration into the economy offers more 
dangers than its introduction by the superior opening of the digestive 
canal. 



ELEMENTS OF DOSIMETRIC PRACTICE. 163 

of artificial cultures. As the number of the microbes 
increases, disease becomes imminent, an attack being 
made as soon as the resistance of the sympathetic is in- 
sufficient to hold out against the disturbed equilibrium 
which is caused by the specific agent of the disease. 
Some further chemical and pathological considerations 
will justify to a still greater degree this way of under- 
standing the pathogenesis of cholera. In comparing 
this type of microbiosis with other zymotic diseases, we 
see that there is a complete disparity as to their symp- 
toms. In variola, typhus, yellow fever, the plague, 
etc., the disease is constituted by two essential elements, 
the reaction of the organism to the parasites which have 
invaded it, and their elimination as foreign bodies. The 
disease is therefore general, prolonged, and cyclical. 
In cholera there is nothing of the kind ; all the symp- 
toms are acute, and are evolved in a short time. There 
is no reaction preceding elimination, and the disease 
shows such a degree of gravity, such variable symptoms 
and progress, that one is compelled to admit that, be- 
sides the primary cause, the principal element of the 
disease lies in the nervous system. The microbes, after 
having caused intestinal transudation, as a result of 
vaso-motor paralysis, are themselves the means for 
effecting their own elimination, or rather evacuation. 
The intestine, having thus been freed from the microbes, 
the remainder of the morbid evolution is entirely physi- 
ological. After paralysis has occurred there is neces- 
sarily a more or less decided tendency toward reaction ; 
the intestines become irritated and inflamed, the tem- 
perature becomes elevated, and gives occasion for a new 
disease, which we might call curative, were we not con- 
tent with calling it physiological. This disease has 
nothing specific about it. It is not contagious while it 
lasts ; neither the blood nor the secretions contain in- 
oculable material ; the condition is one which predis- 
poses to a new attack rather than otherwise. Cholera 
itself, therefore, expends itself entirely in the intestine, 



164: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

while the organism at large intervenes only through the 
medium of its nervous sensibility. However insensible 
the intestinal nerves may become to stimulants and to 
peripheric influences, the cholera will pass away almost 
unperceived. This is the explanation of the efficiency 
of opium in certain cases, and it is for the same reason 
that we must limit ourselves to stimulation of the vital 
energy, and to diminution of the peripheric sensibility, 
without seeking in any way to arrest the evacuations, 
which are the unique but natural means for shortening 
the attack, by eliminating the cause which produces it. 
Opium, which is very useful for curing simple forms 
of diarrhoea, which might quickly become choleraic in 
character as the composition of the intestinal fluids be- 
came modified, becomes harmful after the cholera is 
established, by increasing the time during which the 
disease-germs are in contact with the organism, and 
thus supplying new generations of them for the attack. 
The following conclusions may be advanced as to the 
relations of the symptoms : 

1. Cholera is produced by a microbe, which Koch 
thinks he has discovered, and which he has called the 
comma-bacillus. 

2. The cholerigenic germ is developed in Europe 
only in the intestinal fluids. 

3. The germ is introduced into the organism through 
one of the orifices of the intestinal canal. 

4. The primordial lesion of cholera is a paralysis of 
the intestinal nerves. 

5. All other symptoms are secondary to this paraly- 
sis. 

After these considerations, which are based upon 
incontestable facts, we are now in position to find a 
rational plan of defense and attack with reference to 
this terrible scourge. We shall, therefore, study in a 
concise manner the practical consequences which must 
follow to accomplish the preventive, curative, and pre- 
servative treatment of cholera. 



ELEMENTS OF DOSIMETRIC PRACTICE. 165 

Preventive Means. — It is evident that quarantines 
and sanitary cordons are useful for the arrest of indi- 
viduals who have been sojourning in infected places, 
and have brought with them germs and microbes, the 
vitality of which depends upon certain conditions which 
are unknown to us, but which we know exist naturally 
only in the East Indies. These germs can not long sur- 
vive in the climate of northern and central Europe. 
Since these microbes can exist, however, in individuals 
who are apparently healthy, as well as in the sick, 
quarantine should continue for a longer time than is 
usually the case, and all immigrants should be sub- 
mitted to intestinal disinfection with sulphide of cal- 
cium and Sedlitz Chanteaud. The dejections of those 
who are in quarantine should be burned, removed to a 
great altitude, or mixed with sulphuric acid, so as to 
disorganize their living elements. A healthy individ- 
ual, who comes from a center of infection, may be a 
more decided cause for suspicion and danger than one 
who is actually suffering from cholera, for the latter, 
overcome by the disease, can only infect a latrine, a 
house, or a single place of residence ; the former, on 
the other hand, being entirely unrestrained in his 
movements, distributes the choleraic germs wherever 
he goes and wherever he leaves his dejections, thus 
creating new centers of epidemic proliferation. While 
quarantine thus established is useful, it is altogether 
insufficient, since the germs disseminated by the at- 
mosphere are easily blown across such barriers. How- 
ever, as it has been already observed, they become 
more innocent and impotent the longer they exist, so 
that a point may be reached when they cease to be so 
harmful as when transmitted directly by man. The 
great means of prevention, and the only effective ones, 
would be to destroy, from the beginning of the epi- 
demic, all the dejections of all the inhabitants in the 
region which has been attacked. This end ought not 
to be so very difficult to attain. 



166 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Counteracting Means. — These general means ought 
to be completed by the care which is taken by each 
individual that he does not furnish in his own person 
a suitable soil for the culture of the germs of the bacil- 
lus. In order to attain that end, it will be necessary — 

1. To avoid the introduction of germs into his di- 
gestive tube. 

2. To render the conditions which are suitable for 
the development of the microbe incompatible with the 
nature of the liquid contained in the intestinal canal. 

In order to avoid the introduction of germs, one 
should use the greatest care in avoiding all places for 
evacuating the bowels which are not thoroughly disin- 
fected, either by boiling water or by a suitable disin- 
fecting solution, sulphuric acid being the most reliable 
of them. The objects which are used for cleansing pur- 
poses should be changed on each occasion of use, and 
thoroughly disinfected. Water and instruments for 
administering enemata may readily become media for 
the transmission of the disease. No food which has 
not been recently cooked should be eaten. 

Water should be boiled ; but, as it is indigestible in 
this condition, and by aerating it it again becomes 
dangerous, weak wines should be drunk in preference, 
or waters from mineral springs or from localities which 
are known to be free from the cholera infection. Fil- 
tered water which contains five parts of borax in a 
thousand may be considered free from danger. Be- 
tween meals those who have disorders of the intestinal 
canal, or who must be near the sick, should occasion- 
ally dissolve in the mouth a pastille of borax or a gran- 
ule of sulphide of calcium. The studies of Ballesteros 
lead us to regard the latter as a useful preservative 
agent ; two granules may be given two to four times 
daily. The windows should be closed as night comes 
on, but all of them should remain open during the day. 
Colds and errors of diet must be avoided ; for, as they 
excite the intestinal secretion in either a direct or reflex 



ELEMENTS OF DOSIMETRIC PRACTICE. 167 

manner, they render the composition of the contents of 
the intestinal tube favorable to the development of the 
microbe. The daily use of Sedlitz Chanteaud may be of 
service in preventing fermentation in the digestive canal ; 
but dosimetric physicians are divided in regard to this 
point, some of them agreeing with the general opinion 
that it is best to abstain from the use of purgatives while 
Asiatic cholera is epidemic. It must be remembered, 
however, that purgation from the use of salines is not 
analogous to the premonitory diarrhoea of cholera. 

Esallden stated in the "Union Medicale," in 1849, 
that he had prescribed, during a recent epidemic of 
cholera, purgatives and emeto-cathartics by the hun- 
dred, cholera not being the result in a single case. He 
even stated that the use of evacuants, by combating 
dyspeptic and diarrhoeal conditions, would result in 
saving some individuals from an attack of cholera to 
which they were predisposed. Fonssagrives,* in com- 
menting upon this opinion, agreed with its author, and 
approved of the moderate use of purgatives. Each one 
must act in this matter according to the best of his 
judgment ; but it would seem proper that those who 
are accustomed to the daily use of a rectal enema should 
continue it, while those who are doing well without it 
should not change their habits in this respect without 
good cause. In the same way, those who require, 
and are in the habit of using, Sedlitz Chanteaud to 
correct gastric troubles, should not give up its use 
through any puerile fear. Whatever goes to main- 
tain health in body and in mind should be contin- 
ued without hesitation. To advise one to abstain from 
fear is easy enough, but its practice is difficult. The 
daily use of strychnine, by acting as a tonic to the 
nervous system and a stimulant to the mind, should be 
of great service. The author remembers to have heard 
Dr. Burggraeve remark that it was his habit to take a 
few granules of strychnine before proceeding with an 

* u Traite de Therapeutique appliqnee," tome ii, p. 511. 



168 ELEMENTS OF THERAPEUTICS AND PRACTICE, 

important conference ; and his pupils have been in the 
habit of saying that, under such influences, his exposi- 
tion of his doctrine and his refutation of the objections 
which were made to it were wont to be made with 
more than usual clearness and earnestness. .Leptan- 
drine, which is advised by Paquet, and which, in that 
author's opinion, has the property of exciting the he- 
patic and intestinal nervous centers, may be associated 
with strychnine, or be given alternately with it. 

Curative Means. — If one seeks the most appropriate 
means, according to classical authorities, for combating 
this disease in its different phases and according to its 
different indications, a feeling of fatigue and discourage- 
ment must follow, for, among all the remedies which are 
considered appropriate, there is not one which could be 
recommended with a degree of confidence which would 
inspire success. It might be supposed that the scien- 
tific progress which has developed since the occurrence 
of the last few epidemics of cholera would imply cor- 
responding progress in the practical application of that 
knowledge. Unfortunately, the most varied methods 
of treatment have been tried in cholera-hospitals in the 
different countries of Europe without a single step of 
progress on the part of therapeutics, or the least ad- 
vantage over the ancient methods of treatment. At 
the Pharo Hospital, in Marseilles, Trastour has had 
occasion to compare the results obtained by different 
means, the latter being advised as means which are 
most rational, and indicated as those which are most 
efficacious. The methods by the bichloride of mercury, 
as a germicide, and oxygenated water, produced no 
result ; the physiological method of treatment with 
picrotoxine, which produces elevation of the tempera- 
ture, was equally unsatisfactory, as might have been 
supposed ; inhalations of oxygen revived the patients 
for only a moment ; injections of water into, the veins, 
which was practiced upon two patients, did not prevent 
them from succumbing in a very few hours. The ex- 



ELEMENTS OF DOSIMETRIC PRACTICE. 1C9 

citant method of treatment with ether and acetate of 
ammonia appears to have given better results, bnt has 
not served to lower to any considerable degree the mor- 
tality in epidemics in which this plan has been fol- 
lowed. Of two hundred and eighty patients which 
Trastour received at the hospital in a condition which 
would indicate that recovery was possible, one hundred 
and forty-six died. In epidemics which preceded the 
one from which these statistics are derived, in which 
some patients were treated and others were not, the 
mortality was about the same — that is, about fifty per 
cent. Therefore, since science has taught us nothing 
new in this matter, let us see whether any advantage 
can be gained in the way of establishing a rational 
method of treatment by departing from its principles. 
From the foregoing observations it must be evident 
that the principal indications can be reduced to two : 

1. To destroy the microbes and prevent the develop- 
ment of germs, thus annul] ing the cause of the disease. 

2. To stimulate nervous vitality by means of all the 
most energetic excito-motor agents, in order to combat 
the primary functional lesion, paralysis of the intestinal 
nerves, from which all other disturbances and symp- 
toms proceed. 

To satisfy the first indication, we possess -the sul- 
phide of calcium, the probable efficiency of which is 
estimated by the magnificent results which it gives in 
the other mycoses, and which has the great advan- 
tage of being readily tolerated. Of what practical 
advantage is it that agents, such as corrosive subli- 
mate, sulphate of copper, and carbolic acid, are capa- 
ble of destroying micro-organisms outside the body if 
they can not be introduced into the digestive canal in 
sufficient quantity and in a suitable degree of concen- 
tration to accomplish the desired result ? Shall we sub- 
mit the body to a temperature of one hundred and ten 
degrees, since that temperature is necessary to destroy 
these germs % The ideal of the investigators should be 



170 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

a parasiticide which will kill the microbes without at- 
tacking at the same time the integrity of the digestive 
organs ; and, since sulphide of calcium fills these two 
conditions, so difficult to unite, it would appear that 
this is the agent which should be preferred — at least in 
the present condition of science— as the therapeutic 
agent in cholera.* The second indication should be 
filled by means of strychnine and phosphoric acid, 
which are the most energetic antagonists to paralysis. 
As soon as we have restored the equilibrium of the 
intestinal nervous functions, and the microbe has dis- 
appeared from the enteric mucous membrane, the entire 
disease will vanish as if by magic, and we will have 
remaining only an ordinary disease to treat, in which 
fever or atony will predominate, and the treatment of 
which will demand no unusual manifestations. If the 
progress of the disease is not very rapid, we may be 
able to use certain other medicaments, which would 
therefore come under the role of the variant. Spasms 
may be combated by the bromide of camphor, sup- 
pression of urine by digitaline, suppression of perspira- 
tion and elevation of the internal temperature by aconi- 
tine, and intermittence in the symptoms by the valeri- 
anate or salicylate of quinine. During convalescence 
the atony of the stomach may be treated by leptandrine 
or quassine, three granules of each before meals ; the 
epigastralgia by a well-regulated diet, and by two gran- 
ules of the tannate of cannabin every half -hour until a 
soothing effect has been obtained. Before finishing 
this subject, it is proper to make an observation with 
respect to the method of administration and fixation of 
the doses of the drugs which are required, and also to 
remind the physician that it is necessary to combine 
internal treatment with external applications. In cases 
in which the functions are only moderately deranged, 
the administration of medicaments should follow the 

* The results which Ballesteros has obtained fully confirm the fore- 
going statement. 



ELEMENTS OF DOSIMETRIC PRACTICE. 171 

ordinary rules. For the so-called premonitory diar- 
rhoea, which is nothing less than an attack of cholera 
in its embryonal stage, we should use morphine, bru- 
cine, or strychnine, from one to three granules, at in- 
tervals varying from a quarter of an hour to two hours, 
according to the severity of the case. With these drugs 
we may associate sulphide of calcium in suspicious 
cases. If, on the other hand, the cholera is established, 
and the intestinal paralysis is beginning to pass away, 
we should remember that repeated vomiting and fre- 
quent intestinal evacuations, with the associated abun- 
dant intestinal transudation, mean that the greater por- 
tion of the medicines which have been taken are of no 
benefit, and that, in addition, the absorption of the 
remainder is very uncertain and irregular. Even if 
there is no vomiting, substances traverse the intestinal 
canal with such rapidity that hardly any portion of 
them can be of much utility. Under these circum- 
stances we should not give medicaments in the solid 
condition, but dissolve them in water, or in port or 
madeira wine, or else in some warm, stimulating infu- 
sion, being careful to avoid irritating vehicles, which 
would greatly aggravate the period of reaction. Dur- 
ing the period of intestinal hypersecretion, the doses 
should be very large and frequently repeated, if we 
wish to obtain any result from the use of medicines. 
The limit of the doses should be subordinated to the 
rapidity with which the evacuations are repeated ; and 
as the diarrhoea becomes subdued, and we look for a 
more nearly normal degree of absorption, the frequency 
with which they are given should be correspondingly 
diminished. In the asphyxial period we should have 
recourse to hypodermic injections of excito-motor alka- 
loids ; for, if they do not give all the results which we 
could hope for, they are a]l that is left us for this ex- 
treme period. It is well to begin using them sooner 
than is customary, and also in a somewhat different 
way. Injections consisting of one centigramme of hy- 



172 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

droclilorate of morphine and one half a milligramme 
of atropine to a gramme of water may be of service in 
checking the vomiting, which wears out many patients, 
and completely disturbs the regularity of the treatment 
which is prescribed for them. Injections of a ten-per- 
cent solution of hydrate of chloral, used almost simul- 
taneously at four points — two on the arms and two on 
the thighs — have sometimes been successful in relieving 
the cramping pains, and are also perhaps antizymotic. 
Under the same conditions, and in the same manner, 
the hydrobromate of quinine may be used in a two-per- 
cent solution. There may be a particular indication 
for pilocarpine to re-establish the urinary function, but 
it must be used with moderation on account of its 
depressing effects, which would be an obstacle to the 
establishment of the necessary condition of reaction. 
The exciting properties of ether may sometimes be used 
in extreme collapse ; one gramme of it pure should be 
injected at each attempt. All these means must be 
regarded as designed only to restore the vitality, that 
then the alkaloids destined to fill the dominant indica- 
tion may have time to produce all their effects. Ap- 
plications of electricity may also be of great service as 
synergistics in the result which is expected from strych- 
nine and phosphoric acid. Fumigations, after the 
method of Guy ton, * and recommended also by Burg- 
graeve, will contribute to the purification of the air of 
the sick-room, and increase the volume of oxygen for 
the patient already troubled as to his respiration, while 
they will also diffuse the disinfecting fumes of chlorine. 
Everything which can stimulate the activity of the 
skin, and provoke a healthful derivative action toward 
it, should be tried. Of all the means which have been 

* This method was devised by Guyton de Morveau. The mixture 
consists of three parts of binoxide of manganese, one of chloride of 
sodium, and two of dilute sulphuric acid. This disinfectant gave excel- 
lent results when it was used, in 1809, by Thome Rodriguez Sobral, a 
distinguished chemist of Coimbra. 



ELEMENTS OF DOSIMETRIC PEAOTICE. 173 

used up to this time, derivatives upon the skin have 
given the most constant and the most advantageous 
results. This fact is explained by the antagonism 
which subsists between the cutaneous circulation and 
that of the mucous membrane, as was shown by the 
experiments, already quoted, of Dastres and Morat. 
The theory is that, if intestinal vaso-dilatation coin- 
cides with cutaneous vaso-constriction, cutaneous vaso- 
dilatation will in its turn be accompanied by intestinal 
vaso-constriction, which is an indispensable factor in 
the cure of cholera. Consequently, we should not de- 
spair of success, but persevere in the use of dry rub- 
bings, rubefacients, stimulants, etc. With regard to 
the use of the hot blanket, the author hesitates to ex- 
press an opinion. Though coverings are moistened in 
boiling water, the patient will be exposed to a chill 
while they are being adjusted, the consequence of 
which will be cutaneous vaso-constriction and an ag- 
gravation of the intestinal vaso-dilatation. Coverings 
dipped in cold water would be preferable if one were 
sure of an immediate reaction, but, under the condi- 
tions of this disease, reaction after such means is so 
problematical that the risk is not usually warrantable. 
Sometimes it might be advisable to wrap the patient, 
in a nude condition, in a dry blanket as warm as the 
natural temperature of the body. Whenever it might 
be necessary to uncover him, repeated strokes might 
be made over the entire body with towels moistened in 
cold water. 



/ Infection by the comma-bacillus Sulphide of calcium. 

Dominant, -j Paralysis of intestinal innerva- ( Phosphoric acid, sul- 

', tion ( phate of strychnine. 

Cramps Bromide of camphor. 

Anuria Digitaline. 

Fever Aconitine. 

Intermittence .... Salicylate of quinine. 

f Codeine. 



; Variant. 



Vomiting J Hypodermic injections 

& < J of morphine and at- 

[ ropine. 
Gastric atony .... Leptandrine, quassine. 
Epigastralgia .... Tannate of cannabine. 



174 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Chorea. — Chorea is a neurosis from which one may 
recover spontaneously in the course of three months, 
more or less, but which nevertheless may, and not 
infrequently does, lead to a fatal issue. Its patho- 
genesis can not be readily explained ; the most reason- 
able theory is that which attributes it to an original 
lesion of a rheumatic nature located in the spinal neu- 
rilemma. The disease affects principally the co-ordina- 
tion of the motions and the economy of muscular con- 
tractility. The pharmaco-dynamics of veratrine cor- 
responds perfectly as dominant with the indications 
suggested by this pathogenic conception, and trials of 
it have been made by the author with admirable and 
rapid results. It should be given in relatively large 
doses, and it is so well tolerated in such doses that it 
would seem as if vegetative contractility in choreic 
patients who received such treatment had been blunted 
by the excessive excitability from which the muscles 
are suffering. 

Two or three granules should be given, therefore, 
every half- or quarter-hour, day and night, with the 
greatest regularity, until there is a manifest improve- 
ment in the condition, or evidence of insurmountable 
intolerance on the part of the stomach. In the latter 
case we should not be discouraged, and should add two 
granules of codeine to each dose of veratrine ; if vomit- 
ing continues, in spite of this change of method, we 
should rest for a few hours, and then begin again with 
doses of one granule, which should be rapidly increased 
until the dosage originally prescribed is reached. 

We must not hesitate to keep the patient entirely 
under the influence of the veratrine for three, five, or 
eight days, increasing the doses if at the end of three 
days we have not obtained the desired result. As long 
as the stomach does not reject the drug, nor the pulse 
indicate a condition of great depression, we can con- 
tinue the treatment fearlessly, always seeking to avoid 
an interruption to the influence of the drug, which 



ELEMENTS OF DOSIMETRIC PRACTICE. 175 

might annul the entire effect. Most patients are not 
sufficiently careful to prevent such interruptions, espe- 
cially at night. 

It must also be remembered that this plan of treat- 
ment is recommended only for idiopathic or essential 
chorea. If the chorea is symptomatic, it would be use- 
less to follow this method. 

The pains which accompany the ataxia, especially 
at the beginning of the disease, should be combated by 
cicutine, two granules every two hours, or by tannate 
of cannabine, two granules every half-hour. Prolonged 
lukewarm baths may be used to counteract the hyper- 
esthesia. The anaesthesia requires no other treatment 
than the dominant ; suitable local means may be added 
as they are applicable, if desired. Among such means 
metallo therapy, xylotherapy, etc., may be used. 

The cardiac disturbances may result in an ataxic 
condition as to the heart's movements, in which case 
the treatment need not of necessity be complicated, or 
fatigue in the heart-action may be apparent from loss 
of strength. In the latter case one granule of digi- 
taline, with two of sulphate of strychnine, should be 
given four times daily. Digestive troubles, which are 
complications of ordinary occurrence in this disease, 
should be treated with one granule of hyoscyamine 
every two hours if there is vomiting ; by two to four 
granules of quassine, before each meal, if there is an- 
orexia ; or by three granules of pepsin with each meal, 
if there is trouble with the gastric secretions. 

The anaemia, or chloro-ansemia, which is manifest 
after the first few days of choreic ataxia, should be 
treated with two to three granules of the valerianate 
of iron or of arsenious acid with each meal. Insomnia, 
which has so great an influence in depressing the 
strength of the patient, should be combated with the 
hydrochlorate or the hydrobromate of morphine, associ- 
ated with croton chloral or the monobromide of camphor. 
Three granules of each may be used every half -hour. 



176 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



[ Dominant. Want of co-ordination 
/Pain . 
Anaesthesia . 
Hyperesthesia 

Cardiac perturbations 



Veratrine. 

Tannate of cannabine, cicutine. 

Local measures. 

Cicutine. 



j Digitaline. 
I Stryc 



k Variant. ( 



Digestive disturbances 



Anemia 



Insomnia 



Strychnine. 
( Hyoscyamine. 
•j Quassine. 
( Pepsin. 

Valerianate of iron. 

Arsenious acid. 

Hydrochlorate of morphine. 

Bromide of camphor. 

Croton chloral. 



Cirrhosis of the Liver.— See Interstitial Hepatitis 
(under Hepatitis). 

Colic, Hepatic. — See Biliary Litliiasis (under 
LitMasis). 

Congestion, Cerebral. — The therapeutics of cere- 
bral congestion should always be based upon positive 
indications, for in diseases of this character, more than 
in all others, the result depends upon the interpretation 
of the case. The investigation of the case should be 
complete, and should apply with more thoroughness 
and exactness to the patient's past history than to his 
present condition. While it may be easy to make a 
diagnosis quickly in a case of this kind, it is not so easy 
to say under what conditions the hyperemia is pro- 
duced ; but these are the very conditions which will 
indicate the proper line of treatment. Active conges- 
tion of the brain may occur, whether from the sup- 
pression of a periodical flow (as in connection with 
haemorrhoids or menstruation), or from the accumula- 
tion of blood in the brain in consequence of a sudden 
diminution of the capacity of the general circulation 
(as by means of ligatures, compression of the vessels, 
etc.). There is, then, a collateral hyperemia of physi- 
cal origin, and which must be treated on hydraulic 
principles — that is, by removing as much blood as will 
be necessary to restore the equilibrium of the vascular 
pressure. To accomplish this end we may use general 
or local bleeding ; we may obtain serous discharges by 



ELEMENTS OF DOSIMETRIC PRACTICE. 177 

means of pilocarpine, which will at the same time in- 
crease the salivary, sudoral, and renal discharges, or 
we may use saline purgatives. But, even in these 
cases, we have something besides a physical accumula- 
tion of sanguineous fluid to deal with. This accumula- 
tion might be again distributed equably in all the ves- 
sels, or be carried to some other organ than the brain. 

Therefore, the existing condition is principally a 
certain want of vital equilibrium — a want of resisting 
power in the cerebral vessels — which demands the ad- 
ministration of strychnine and of ergo tine, in order to 
give to the dilated vessels the necessary tonicity to 
enable them to oppose a new hypersemia, which will 
return, after the abstraction of blood by operation, with 
returning plethora. Hypersemia may also originate in 
the brain itself, in consequence of increased irritability 
in that organ. Congestions produced by the presence 
of some morbid product, or by the want of cerebral rest 
(as in vigils, excessive intellectual labor, etc.), are in- 
stances of this mode of causation. In these cases the 
congestion is the first phase of an approaching en- 
cephalitis. Aconitine and digitaline, one granule of 
each being given every half -hour until an effect is pro- 
duced upon the circulation, are indicated, and have a 
rapid and certain action. Revulsives must be avoided, 
the stimulation to the brain which follows their use 
being just what we should aim to obviate. Complete 
rest to the nervous system is an end which must be 
assiduously sought. The hypersemia may also be reflex 
in character — that is to say, the impression upon the 
brain of a cause which is more or less remote. 

An example of this might be noted in the bad re- 
sults which sometimes follow the use of revulsives ; it 
may be added, however, that this means of treatment 
is not always contra-indicated in this form of cerebral 
congestion. Reflex hypersemia, in most cases, is at- 
tributable to the stomach ; Sedlitz Chanteaud and the 
other evacuants are therefore appropriate. In all cases 
12 



178 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

of active congestion we can use cocaine with great ad- 
vantage, its anaemic effects extending to the brain, 
especially if it is administered hypodermically. Three 
granules of it may be used every quarter of an hour. 

Passive congestion may be caused by interference 
with the return of the blood to the heart, whether by 
an immediate obstacle, which causes an accumulation 
of the blood in the head, such as a tumor of the neck, 
which might compress the jugu]ar veins, or by remote 
obstacles, which act in an indirect manner — for exam- 
ple, cardiac or pulmonary lesions. In the first condi- 
tion the application of leeches to the nasal fossse, the 
mastoid region, or the neck, should first be made, to 
prevent accumulation of the blood by withdrawing a 
portion of it. As soon as depletion has been obtained 
to a sufficient degree, strychnine must be used to pre- 
vent an immediate return of the same phenomena. In 
the second case means must be used which will restore 
the equilibrium in the circulation, and among such 
means digitaline, caffeine, strychnine, and Sedlitz Chan- 
teaud will be found especially serviceable. Since con- 
gestions, whether active or passive, do not always have 
the same symptomatic characters, we must sometimes 
fill, as a variant, indications which are peculiar to a given 
case. Headache in connection with active congestion 
may be successfully treated with aconitine, and in pas- 
sive congestion with the citrate of caffeine. One gran- 
ule may be used in each case every half -hour. Yertigo, 
which is a means of terror to patients, and may in this 
way aggravate the congestion, will disappear under the 
use of two granules of the valerianate of caffeine every 
half-hour. 

Constipation will yield to the continued use of Sed- 
litz Chanteaud or podophyllin, or in very rebellious 
cases to the combination of these purgatives with 
strychnine or euonymine. Of the strychnine, two 
granules may be given with each dose, or five of the 
euonymine. Delirium, which depends almost always 



ELEMENTS OF DOSIMETRIC PRACTICE. 179 

upon localized congestion in the gray matter, should 
be combated, at its first appearance, with aconitine, 
associated with the bromide of camphor. Three gran- 
ules of camphor and one of aconitine may be used as 
often as indications warrant. In the comatose or apo- 
plectic condition it is not essential to give anything in 
a fluid form to the patient, not only because it is doubt- 
ful whether the stomach retains its power of absorp- 
tion, but especially because there is risk that fluids 
may enter the respiratory passages on account of the 
abolition of the movements of deglutition, and thus 
increase the difficulties of respiration and accelerate 
asphyxia and death. In the apoplectic form all medi- 
cation should be hypodermatic. If there is indigestion, 
injections of five to ten granules of apomorphine will 
excite vomiting ; if there is evidence that a haemorrhage 
has taken place, we must use injections of ergotine ; if 
the temperature increases, and the pulse becomes more 
frequent and harder, we must not hesitate, as a last 
resort, to use injections of aconitine.* The disturbance 
which extends to all the vital acts from the cerebral 
trouble necessitates the greatest care with respect to 
the alimentation of the patient ; for, while indigestion 
on the one hand may renew the congestion, exaggerated 
or prolonged abstinence may lead to the same accident, 
on account of the excess of impressionability and vas- 
cular relaxation which accompany organic debility. 

* The hypodermic syringe usually contains twenty drops of liquid. 
It will dissolve twenty granules of apomorphine, of which five drops 
may be injected every ten minutes until vomiting is produced. The 
same quantity of water may be used to dissolve ten granules of ergo- 
tine, which is a proper quantity for each injection, and may be repeated 
every half-hour until the patient recovers consciousness. 

Four granules of aconitine may be dissolved in the same quantity of 
water, five drops to be injected at a time, and repeated every hour until 
the effect is noticeable upon the pulse and temperature. 

In passive congestions, due to asystole and dangerous to life, injec- 
tions of fifteen drops of liquor ammonia in fifteen drops of water may 
be made into the median cephalic vein. 



180 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



Dominant. 



Variant. 



r Collateral 

Active congestion -j irritative 

I Reflex . 

f Direct 
^Passive congestion -j 

[indirect . 



(Cephalalgia . 
Vertigo 
Coprostasis . 
Delirium 
Coma . 



j Depletions of blood and 
\ serum, strychnine. 

Aconitine, digitaline, 
cocaine. 

Revulsives, derivatives. 
C Leeches in the nasal 
< fossae or around the 
( ears. 

{Digitaline, strychnine, 
caffeine, Sedlitz Chan- 
teaud. 

Aconitine, citrate of caffeine. 
Valerianate of caffeine. 
Sedlitz Chanteaud, podophyllin. 
Bromide of camphor, aconitine. 
Flagellations. 
Intravenous injections of dilute am- 



Congestion of the Liver. — Few of the organs of 
the body are so susceptible to hyperemia as the liver. 
Compelled, as it is, to experience all the disturbances 
which occur to the circulatory system, on account of 
its peculiar anatomical disposition in the course of the 
blood- current, it is also the seat of active changes, and 
the point of convergence of all the media by which in- 
testinal absorption is accomplished. It is not an aston- 
ishing fact, therefore, that the quantity of blood which 
reaches it varies each moment, and is influenced by all 
the conditions which have a bearing upon the status of 
the general circulation. These changes, which were re- 
ferred to, are diminished in a favorable manner owing 
to the extensive ramification of the vessels, both the 
aiferents and the efferents, within the structure of the 
liver. Hepatic hyperemia may, therefore, go beyond 
certain limits, or continue for such a period of time as 
to be considered a morbid condition. 

But, even with this restriction, it is very often ob- 
served that there are well-defined congestions of the liver. 

Congestion of this organ depends essentially upon 
paralysis of the pneumogastric ; and this fact has been 
experimentally verified by Yulpian, who cut this nerve, 
and found, by measuring the biliary secretion, that it 
could be increased only as the volume of blood was in- 
creased to a corresponding degree. Upon this experi- 



ELEMENTS OF DOSIMETRIC PRACTICE. 181 

mental fact, of the accuracy of which there can be no 
doubt, rests the dominant in the dosimetric plan of 
treatment of congestion of the liver. 

It consists in the use of that agent which produces 
or provokes nervous force to the most decided degree, 
and which is designed to take the place of the force 
which should be transmitted by the vagus ; that agent 
is strychnine. In order to facilitate the practical appli- 
cation of the dosimetric treatment we must consider 
congestion as mechanical, active, and passive ; really 
admitting, however, that there is no essential difference 
between the three forms, since all depend upon the 
same primary cause, insufficiency of nerve-force. They 
may appear to differ on account of the different ways 
in which they are established, the rapidity with which 
they are developed, and the subjective symptomatology 
which each one presents ; fundamentally, they are one 
and the same thing. Mechanical congestion, which is 
caused by obstacles to the circulation, either without or 
within the liver, is also due to the want of resistance 
on the part of the walls of the blood-vessels to the intra- 
vascular pressure. The treatment should consist (1) in 
destroying or neutralizing the obstacle ; (2) in increas- 
ing the resisting power of the vessels. Both these in- 
dications are filled, if such a thing is possible, by the 
use of strychnine and digitaline. All indirect means 
which would diminish the intravascular pressure would 
antagonize, for the moment, the congestion, but could 
not be considered as curative agents of this disease. 

Purgatives will bring a certain degree of comfort to 
the patient, but that is their only effect. The same 
might be said in regard to bleeding, whether from 
leeches or cups ; but the slight advantage which might 
result is more than compensated by the great risk which 
attends the use of such means. There are cases, how- 
ever, in which the congestion must be relieved by what- 
ever means, even though the result be of but short du- 
ration. 



182 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

For example, in cases in which dyspnoea, produced 
by great enlargement of the liver, is so distressing as to 
demand immediate relief, we must not hesitate to use 
purgatives, and especially those which have the prop- 
erty of exciting the secretions of the liver, as well as 
producing free serous depletion. We should use, as 
such means, podophyllin or jalapine, associated with 
the dehydrated Sedlitz, but without discontinuing the 
strychnine, which, in addition to its role of dominant, 
has also the advantage of fixing and rendering more 
constant the serous ischsemia, which is effected by the 
current of fluids diverted to the surface of the intes- 
tines. As to dosage, three or four doses, consisting of 
five granules each, of podophyllin or jalapine, with a 
solution of Sedlitz Chanteaud, will cause copious evacu- 
ations, containing an abundance of bile. In cases in 
which the principal morbid element takes the form of 
ascites, which we desire to treat with diuretics, we may 
use caffeine, colchicine, or asparagine, associated with 
digitaline and strychnine. Two granules of each may 
be given every three hours. Active congestion has sev- 
eral causes ; their suppression usually suffices to cure 
the patient. Its etiology should therefore be very care- 
fully studied. If the congestion is due to intemperance 
or the use of irritating food, a well-regulated diet and 
the use of sulphate of strychnine with each meal will 
rapidly overcome the hyperemia. 

In tropical regions, where the continuous heat alone 
seems to weaken the force of the hepatic circulation, 
we should prescribe two granules of aconitine morning 
and evening, or oftener if the case requires it. Sup- 
pression of perspiration is also a frequent cause of con- 
gestion of the liver. The nitrate of pilocarpine, by in- 
creasing the contractile force of muscular fibers and 
producing diaphoresis, will be of great service in such 
cases. The dose should be three granules every ten 
minutes, by the mouth or hypodermically. The con- 
gestion which accompanies or follows malarial fever 



ELEMENTS OF DOSIMETRIC PRACTICE. 183 

may be effectively treated by the arseniate of quinine, 
combined with the arseniate of strychnine, two granules 
of each being given three or four times daily. 

Simple congestion, which may accompany syphilis, 
is not of frequent occurrence from such a cause. If 
syphilis be the cause, calomel is indicated, the doses 
being graduated in accordance with the severity and 
chronicity of the disease, and in accordance with the 
rules of dosimetric therapeutics. There are not usually 
any alarming symptoms in connection with the estab- 
lishment of active congestion. It may be accompanied 
with some elevation of temperature, however, and as 
this may be the first indication of an imminent hepa- 
titis, we should use one granule of aconitine every hour 
or half -hour until the temperature has declined to the 
normal again. The pain in the hypochondriac region 
is seldom severe ; if it should become annoying, and 
evidences of inflammation should be present, codeine 
may be administered. 

Anorexia will readily yield to treatment with quas- 
sine, which also seems to excite the flow of the bile. 
Tenesmus may be treated by the purgatives which have 
already been referred to, and by one-granule doses of 
hyoscyamine, repeated as often as necessary. 

Icterus will promptly disappear after treatment with 
arseniate of soda, six to ten granules of which may be 
given daily. 

By this means the digestive functions will also be 
benefited. For passive congestion, whatever its pecul- 
iarity, the liberal use of strychnine can not be dispensed 
with. The indication for this drug is so manifest that 
even Jaccoud appears to advocate it.* In all cases in 
which stasis occurs, strychnine must be used freely, its 

* " It is very probable that the action of the muscular fibers iu the 
intestines and spleen, nnd the contractility of the vena porta, the hepatic 
artery, and veins, are necessary to the regular circulation of the organ, 
and that derangement of these motions may lead to stases." — Jaccoud, 
11 Pathologie interne," 2d edition, tome ii, p. 395. 



184: ELEMENTS OF THERAPEUTICS AND PRACTICE, 

effect being aided by hydrotherapy, especially in the 
form of cold douches. The dominant treatment must 
be re-enforced by that of the variant, according to the 
etiological indications. The stases which result from 
a suppression of the discharge to which the system had 
become accustomed, or which were indispensable for 
the performance of its various functions, can be readily 
combated by aconitine and ergotine, the first having 
the effect of a bloodletting, the second acting upon 
muscular contractility, and thus relieving the abnormal 
pressure in the hepatic canals. One granule of aconi- 
tine and three of ergotine may be used every two hours. 
Habitual constipation may be both a cause and an effect 
of congestion of the liver ; whichever its character may 
be, it is well to treat it with three granules of podo- 
phyllin and two of hyoscyamine, night and morning, 
together with a sufficient quantity of Sedlitz Chan- 
teaud. Sedentary habits of life, acting somewhat like 
paralysis, by requiring very little muscular activity, 
are also a frequent cause of congestion of the liver. 

The best cure for this condition, when it arises from 
such a cause, is an active life, exercise in walking and 
riding, sponge baths, and a spare diet. 

From the foregoing observations it will be evident 
that the treatment of this condition is not so simple as 
the masters in classical therapeutics have described it. 
The alkalies which are advised by them in almost all 
cases can only be of assistance by rendering the blood 
less dense, and thus facilitating its progress through 
the vessels. This advantage is counterbalanced by the 
inevitable tendency of the alkalies to destroy a great 
number of the red corpuscles, to increase or to produce 
ansemia, which is developed by the nervous debility 
which gives rise to passive congestion, and thus to in- 
close the disease in a vicious circle, from which there is 
no relief but the adoption of a different line of treat- 
ment. The diseases which the allopathic practice pro- 
duces, and the paternity of which it ingenuously ad- 






ELEMENTS OF DOSIMETRIC PRACTICE. 



185 



mits, by giving them sonorous and elegant names, give 
us a proof that forces which are out of equilibrium are 
not to be overcome or restored by the application of 
material influences. Anaemia from the use of alkalies 
is an artificial disease which is produced by allopathy, 
a hybrid product of science and blindness. 

CONGESTION OF THE LIVER. 



Dominant. 

Variant. 

Dominant. 
Variant, 



1st. Mechanical. 

Want of heart-force for organic 

disturbances .... 

f" Dyspnoea owing to excessive size 

J of the liver .... 

Ascites 



2d. Active. 
Paralysis of the muscular fibers 
of the vessels, of those of the 
capsule of Glisson, and of the 
abdominal muscles . 
> Fever .... 
Hepatic pain 
Anorexia . 



symptomatic. J Tenesmus . 
Constipation 



Variant, 
causal. 



Dominant. 



Variant, 
causal. 



Icterus 

> Irritating food . 
Elevated temperature 
Suppression of perspiration 

I Malarial infection 

I Syphilitic infection 



3d. Passive. 
( Paralysis of the muscles which 
■< can influence the circulation 
( of the liver .... 
' Suppression of customary dis- 
charges 



Constipation 
t Sedentary life 



j Digitaline, sulphate of 
} strychnine. 
j Podophyllin, jalapine, 
j Sedlitz Chanteaud. 
] Asparagine, caffeine, 
I colchicine. 



Sulphate of strychnine. 



Aconitine. 

Codeine. 

Quassine. 

Hyoscyamine. 

Sedlitz Chanteaud. 

Arseniate of soda. 

Diet. 

Aconitine. 

Nitrate of pilocarpine. 

Arseniate of quinine. 

Calomel. 



/ Sulphate of strychnine. 
f Hydrotherapy. 

Aconitine. 

Podophyllin. 

Sedlitz. 

Exercise. 



Congestion and CEdenia of the Lungs. — Con- 
gestion of the lungs may be either active or passive. 
The first, or fluxion, may be irritative, when the agent 
which produces it acts upon the pulmonary tissue itself ; 
reflex, when it acts upon a distant point, whence the 
irritation is transmitted to the lung ; the result of want 
of equilibrium as to pressure, when the vessels are de- 
ficient as to the degree of external pressure which regu- 



186 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

lates their capacity ; the result of want of equilibrium 
in the circulation, when the intra-vascular pressure is 
increased on account of obstacles which are introduced 
into the circulation. 

Aconitine is the remedy which should be preferred, 
being administered with more or less constancy, accord- 
ing to the degree of the fluxion. One or two granules 
may be given every half-hour, or less frequently. 

Passive congestion results from the retardation of 
the blood in the pulmonary vessels. The stasis in this 
case is due either to an obstruction in the current or to 
weakness of the heart's systole. Two granules of digi- 
taline may be prescribed, two to four times daily. This 
will increase the energy of the heart, and make its 
movements more regular and effective. (Edema is due 
to the transudation of serum through the vessels, in 
consequence either of changes of pressure or of altera- 
tion in the constituents of the blood. The first of these 
causes proceeds from pulmonary lesions, the second 
from general diseases. Aside from the particular treat- 
ment of the original lesions, we may use five granules 
of podophyllin two or three times daily, with a tea- 
spoonful of Sedlitz Chanteaud for each dose of the 
podophyllin. Purgative and diuretic medication may 
be used alternately. Five granules of caffeine, given 
two or three times daily, will fill the latter indication, 
the object being to obtain not a violent but a mild ac- 
tion, which can be continued a long time without excit- 
ing intolerance. In all these cases there is a common 
and principal vital lesion — vaso-motor paralysis. 

However much the congestion may be due to irrita- 
tion or to stasis, to whatever degree the oedema may 
already exist, the vessels dilate because the vasocon- 
strictor nerves do not oppose sufficient resistance to the 
tendency to dilate. The true dominant indication is, 
therefore, strychnine, that reliable vital excitant and 
most faithful regulator of all the substances which act 
upon the organism. For the active congestions prefer- 



ELEMENTS OF DOSIMETRIC PRACTICE. 



187 



ence should be given to the arseniate or the sulphate of 
strychnine, two granules of each every two hours ; for 
the passive congestions two granules of the hypophos- 
phite, four or five times daily, will be appropriate. 
Pain is sometimes present, either before or during the 
period of congestion, and should be met with two gran- 
ules of the hydrobromate of morphine every quarter of 
an hour. 

Haemorrhage, which will often, apparently, abort 
the congestion, is almost always a symptom which is 
followed by bad results, even among those who are 
exempt from all traces of tuberculosis. It should al- 
ways be treated with ergo tine, three granules of which 
may be given every quarter of an hour. Dyspnoea calls 
for digitaline, to aid the heart in relieving itself of an 
excessive supply of blood ; one granule may be given 
every half-hour. Cough, which causes afflux of the 
blood and exaggerates the irritation, may be soothed 
by two granules of codeine every quarter of an hour. 
If a febrile movement should manifest itself, we may 
combine aconitine and digitaline, one granule of each 
every half -hour, repeating until the normal temperature 
is again reached. 



CONGESTION AND OEDEMA OF THE LUNGS. 



Active 
congestion 



Passive 
congestion 

(Edema 



Dominant, 
Irritative . 
Reflex 
From want of equilibrium 

in pressure 
From want of equilibrium 

in the circulation . 
From mechanical obstruc 

tions in the circulation 
From cardiac weakness 

j From local diseases . 
( From general diseases 



Variant, 



Pain in the side 
Haemorrhage 
Dyspnoea . 
Cough 
Fever . 



Hyperemia . Aconitine. 



Atony 



Digitaline. 



Transudation ( ffl* 
of serum } Sedntz . 



Hydrobromate of morphine. 

Ergotine. 

Digitaline. 

Codeine. 

Aconitine. 



188 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Congestion of the Uterus. — Active congestion or 
fluxion of the uterus frequently occurs at the period of 
puberty, in conditions of plethora, and with very irrita- 
ble women. It may be caused by prolonged continence, 
by excessive sexual indulgence, by masturbation, by 
emmenagogues, by suppression of the menses, and by 
colds. 

It almost always comes on suddenly, and is an- 
nounced by a feeling of heat and weight in the pelvis, 
the perinseum, and the sexual organs. It is sometimes 
accompanied by spasms or by uterine colic, due to con- 
tractions which have been excited by the excess of 
blood. The patient remains apyretic, and after a few 
days of rest and careful diet all the symptoms will as 
a rule disappear. 

If these congestions are neglected, an exaggerated 
condition is favored, and sooner or later there may be 
an acute or chronic metritis which can be attributed to 
no other cause. 

Uterine congestion depends, on the one hand, upon 
an accumulation of blood in the organ ; on the other, 
upon a too distensible condition of the walls of the 
uterine vessels. 

Aconitine and ergotine are the agents which will 
restore the uterus to a normal condition ; one granule 
of aconitine and two to four of ergotine being given 
every two hours. At other times the condition seems 
to be caused by a spasmodic condition, which is op- 
posed to the free passage of the blood. 

This is what occurs in congestions which follow 
violent disturbances of a moral character. One granule 
of hyoscyamine every two hours will quickly restore 
the physiological equilibrium. 

Uterine colic, which is sometimes extremely violent, 
has the same cause, and calls for similar though more 
active treatment, one granule of hyoscyamine or of 
valerianate of atropine being required every half -hour 
until an effect is produced. 



ELEMENTS OF DOSIMETRIC PRACTICE. 189 

Together with the uterine congestion there may be 
a similar condition of the bladder, and the frequent de- 
sires to micturate which are symptomatic of it may be 
relieved by two or three granules of the bromide of 
camphor every hour. After the congestion has disap- 
peared we should give for a long time, in gradually de- 
creasing doses, ergotine or sulphate of strychnine, to 
give tone to the organ and ward off a repetition of the 
hyperemia — two granules may be given three to five 
times daily. 

CONGESTION OF THE UTERUS. 

r\^,^r . ™, ( Hyperemia Aconitine. 

Dominant, -j M ^ cular atony Ergotine. 

I Spasms Hyoscyamine. 

Variant. < Colic Valerianate of atropine. 

( Frequent micturition . . . Bromide of camphor. 

Constipation, — This is a symptom which occurs 
in several morbid conditions, and indicates different 
disturbances in the physiological condition of the in- 
testines according as it is caused by changes in their 
contents, or in the activity of their blood circulation, 
their innervation, their contractility, or in the secre- 
tions of the glands which open upon their inner surface. 

The hygienic regimen of an individual, and espe- 
cially the matter of diet, has a great bearing upon con- 
stipation in its various forms. A difference in the 
water that one drinks, a diminution in exercise, a 
moral impression, a change in the hygrometric condi- 
tion of the atmosphere — any of these is sufficient to dis- 
turb the regularity of the intestinal function. 

Constipation is of short duration if its causes are 
also transient. A discussion of the necessary plan of 
treatment for accidental constipation is not required, 
for the simple removal of its cause or the use of a small 
quantity of Sedlitz Chanteaud will relieve the difficulty. 
But, if the causes recur daily, and the constipation con- 
tinues a long time, we can not expect to get rid of the 
difficulty so easily. In such cases it becomes necessary 
to search carefully for the physiological element whose 



190 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

activity is perverted, that is, for tlie predominant morbid 
element, in order to obtain safe and durable results. 
The act of defecation depends upon different factors, 
the most essential of which are the presence of the 
fecal mass, an impressionable condition of the intes- 
tines, an impression transmitted to nervous centers, 
and the provocation of expulsive movements. In ad- 
dition it is necessary that the intestinal canal be not 
obstructed, and that it should be lubricated by the 
secretions of mucus and bile, so that the mass may be 
projected by the contractions of the intestines which 
are exerted upon it. The muscular fibers of the intes- 
tines are arranged in two layers, one of which is circular 
and the other longitudinal, the two layers acting forci- 
bly together in the peristaltic movements of the intes- 
tines. The circular fibers compress the contents of the 
intestinal tube and thus force them onward, but, if this 
constriction is exaggerated or is exerted beyond the 
usual point, spasm will result, the dominant indication 
for which will be hyoscyamine, daturine, or atropine, 
the regulating properties of which in certain forms of 
constipation have long been known. When the spasm 
ends, the longitudinal fibers again become predominant, 
and the physiological equilibrium, without which there 
can be no health, is again restored. One or two gran- 
ules of the before-mentioned alkaloids may be given 
twice daily for several weeks. After regularity of de- 
fecation has been established, it is necessary to con- 
tinue this line of treatment for some time, though in 
diminishing doses, to prevent a recurrence. Intestinal 
paralysis, on the other hand (as a cause of constipa- 
tion), demands the sulphate or the hypophosphite of 
strychnine, in doses of two or three granules, three 
times daily. In other cases, the main cause of the 
coprostasis is to be found in the circulation. There is, 
perhaps, a chronic hyperemia, which by its influence 
upon contractility, upon the secretions, or upon the 
resorption of the intestinal fluids, modifies in different 



ELEMENTS OF DOSIMETRIC PRACTICE. 191 

ways the movement or the composition of the fecal 
mass. There may be various causes for this hyperemia. 
It may be due to a want of physical exercise, to irritat- 
ing elements, or to compression of the abdominal organs, 
etc. The dominant treatment will consist in the use of 
two granules of aconitine two or three times daily, and 
in the removal, at least so far as possible, of the excit- 
ing causes. The fecal mass may also be retained in 
the intestine on account of insufficient lubrication. A 
diminution in the quantity of bile and intestinal mucus 
secreted always produces coprostasis. To increase the 
flow of bile we use cholagogues, among which podo- 
phyllin is especially serviceable. The action of podo- 
phyllin, as used by dosimetrists, is always mild, and 
patients are never annoyed by the griping pains which 
many practitioners ascribe to it, as an inevitable con- 
comitant. The difference in effect may depend upon 
the purity or impurity of the drug. As a regulator it 
may be given in doses of three to five granules every 
evening ; as a purgative, in doses of three granules every 
half -hour, until three or four doses have been given. 
The full effect of this medicine may not be experienced 
for twelve to twenty-four hours. A more rapid and 
profound result may be obtained by combining with it 
small doses of Sedlitz Chanteaud. 

Sedlitz Chanteaud is of itself an excellent laxative, 
which may be used every day without causing either 
pain or exhaustion. As its taste is slightly disagree- 
able, it is well to combine with it an equal weight of 
sugar. For those persons who are subject to constipa- 
tion on account of a want of exercise, or on account of 
the water which they drink, or on account of improper 
alimentation, the Sedlitz will be the best remedy. A 
suitable dose is a teaspoonful with a teaspoonful of 
sugar, in half a glass of water, night and morning. A 
few swallows of water may be taken after this draught, 
which may be taken with relish and profit for a long 
time. 



192 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

An imitation of this salt is on the market, but it is 
nauseating to the taste on account of the impurities 
which it contains. If one is to use this salt systematic- 
ally, it is better to buy it in the original bottles, and 
thus be sure of obtaining the genuine. When con- 
stipation is complicated with other troubles, the Sedlitz 
may be combined with agents which are suitable for 
the complications ; thus we may avoid increasing the 
doses of the Sedlitz. The deficiency in the supply of 
bile may be corrected by the use of three granules of 
colchicine every evening, or by ten granules of euony- 
mine, or by ten granules of iridine. The deficiency of 
mucus, which is indicated by hardness of the faeces, 
and their division into scybalce, calls for two or three 
granules of veratrine half an hour before each meal. 
Jalapine, elaterine, and hydrastine are excito-motors 
of the muscular coats, and excite the secretion of bile. 
They may be used as substitutes for podophyllin, iri- 
dine, or colocynthine, in doses of three to ten granules, 
from one to three times daily. Those agents which 
excite the secretions should be given in such a manner 
as not to exhaust the organs upon which they are to 
act, nor to make them a necessity for those organs. 
The doses should be graduated in accordance with their 
effects, the objects being that the system should suffer 
neither from excess nor from deficiency in the use of 
these drugs. Skill on the part of the clinician consists 
in requiring only what is necessary, and in not termi- 
nating a course of medication too early or too abruptly. 
In the treatment of chronic diseases, since the effect of 
medication is not so evident as in acute ones, we must 
rely upon time and perseverance in place of the activity 
and energy by which the treatment of acute diseases is 
characterized. It is also worthy of note that it is more 
difficult to retain results in chronic diseases than it is 
to acquire them, and this difficulty is mainly due to a 
want of patience on the part of the sick person, or of 
perseverance on the part of the physician, both trusting 



ELEMENTS OF DOSIMETRIC PRACTICE. 193 

too much to fortune, which rewards tenacity of purpose 
rather than audacity. After the fecal mass has reached 
the large intestine, its presence excites contractions in 
different groups of muscular fibers which concur in the 
act of defecation. If the mucous membrane is de- 
ficient in sensitiveness, no impression is communicated 
to the nervous centers, and the faeces accumulate with- 
out a consciousness on the part of the patient that they 
should be evacuated. Inertia of the rectum leads to 
the same result. Palliative means of treatment for this 
condition consist in the use of rectal enemata of cold 
water, and removal of the scybalous masses with the 
finger. Curative means are furnished by the hypo- 
phosphite of strychnine and phosphoric acid, two gran- 
ules of each three or four times daily, or by electricity. 
In cases of inertia, Hve granules of bryonine or of 
colocynthine may be given two or three times daily. 
If the diet is composed of such food as leaves little 
residue after digestion, the evacuations will be less fre- 
quent and less abundant. In such cases there is no 
real constipation, for there is no retention of material. 
The remedy consists in giving a different kind of food. 
In no case is it well to leave the intestinal secretions in 
the digestive canal for a very long time, because, aside 
from other inconveniences, it is indispensable to health 
to keep the passages for elimination and absorption 
free and unobstructed. This end may be accomplished 
by using Sedlitz Chanteaud every other day. Copro- 
stasis which is caused by mechanical obstacles to the 
passage of the fecal mass will be considered under the 
head of intestinal occlusion. Whatever the pathogenic 
cause of constipation, there are certain symptoms which 
frequently accompany it, and may call for special treat- 
ment. The variant requires active means in this as in 
all cases, while the dominant requires means which 
can be used for a long time without danger ; it may be 
necessary to vary the dosage, or even to substitute its 
succedanea, but the indication continues constant. 

13 



194 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



Headache, which is present in some cases whenever 
there is the least irregularity in the intestinal func- 
tions, may be treated with two granules of guaranine 
every half -hour, or by one granule of aconitine, if there 
are signs of cerebral congestion, every half -hour, or less 
frequently, according to circumstances. Two granules 
of caffeine may be given every quarter of an hour for 
the vertigo. Want of appetite and gastric catarrh, 
which frequently occur in connection with habitual 
constipation, may be treated with two granules of quas- 
sine every three hours, or four granules of col ocyn thine 
night and morning. Lumbar pains, which are indica- 
tive of congestion of a particular character, may be 
treated by one granule of aconitine every two hours. 
Eructations, which occur when there is intestinal pa- 
resis, will quickly be controlled by three granules of 
brucine or two of sulphate of strychnine three to four 
times daily. Colic may be soothed with one granule 
of hyoscyamine every half-hour, or two of gelsemine 
every quarter of an hour. 

Spasm 

Paralysis 
Hyperemia . 
Deficient secretion 



/Dominant. 



atropine, 



of mucus 
of bile 



Anaesthesia 



Torpor 



Mechanical obstacles 

1 Headache 
Vertigo . 
Want of appetite . 
Lumbar pains 
Eructations . 
Colic 



j Hyoscyamine, 

\ daturine. 

] Sulphate and hypophos- 

\ phite of strychnine. 

Aconitine. 

Podophyllin. 

Veratrine. 

Rectal enemata.bryonine, 
colocynthine. 

Proper diet, Sedlitz Chan- 
teaud. 
j (Under Intestinal Occlu- 
( sion.) 

Guaranine, aconitine. 

Citrate of caffeine. 

Quassine, jalapine. 

Aconitine. 

Brucine, strychnine. 

Gelsemine. 



Coryza. — See Rhinitis. 

Croup,— See Diphtheria. 

Cystitis. — Inflammation of the bladder may arise 
from different causes. At one time it may be caused 
by cold or by traumatism, including in the latter term 



ELEMENTS OF DOSIMETRIC PRACTICE. 195 

difficult parturition and maladroit catheterization ; at 
another by the extension of an inflammation in neigh- 
boring or contiguous organs ; at another by direct irri- 
tation of the mucous membrane from contact with a 
foreign body, or with urine which contains an irritating 
substance which has been eliminated by the kidneys, 
or is due to decomposition of the urine itself. In the 
greater number of cases of acute cystitis a cure results 
from the suppression of their cause ; but the disease 
not infrequently becomes chronic, and the effect per- 
sists after the cause has disappeared. In the treatment 
of simple acute catarrhal cystitis aconitine should be 
the dominant. As long as the symptoms indicate in- 
flammation of the vesical mucous membrane, whether 
there be an accompanying febrile condition or not, we 
should use aconitine at longer or shorter intervals, ac- 
cording to the severity of the inflammation. One gran- 
ule may be given every quarter of an hour, every hour, 
or every two hours, until the desired result is obtained. 
The temperature in some cases reaches 40° C. If there 
are decided intermissions, either in the fever or in the 
other symptoms, twenty granules of hydrobromate of 
quinine may be given every two hours. Acute cystitis 
is always accompanied by pain, which is more or less 
severe in character. At times it is localized in the 
hypogastrium, at others it radiates to the perinseum, 
the testicles, etc. If much suffering is experienced, 
two granules of cicutine may be given every hour until 
the pain is relieved. Tenesmus, which is sometimes 
unendurable, may be treated with one granule of hyos- 
cyamine every half -hour until micturition becomes less 
frequent, or until the physiological effect is produced. 
Hyperesthesia of the mucous membrane, which causes 
the urine to produce a scalding sensation and compels 
one to empty the bladder frequently, may be relieved 
with three granules of the monobromide of camphor 
every half -hour. 

Sedlitz Chanteaud should be taken freely, not only 



196 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

for the purpose of keeping the bowels freely open, but 
also to alkalinize the urine. If the sphincter is con- 
tracted to such a degree as to prevent free discharge of 
the urine, retention may result, which in some cases 
will require surgical attention. These means should 
never be employed except in cases of great urgency, 
and only after the use of such alkaloids as hyoscya- 
mine, daturine, and atropine, which will tend to dilate 
the sphincters. Retention, by exaggerating the dilata- 
tion of the bladder, may produce paralysis of its mus- 
cular coats, in which case the administration of the 
sulphate of strychnine will be required to restore vital- 
ity to the contractile elements. One granule may be 
given every half -hour, and hyoscyamine may be com- 
bined with it if the circular fibers show an exaggerated 
tonicity. Chronic cystitis is singularly rebellious to all 
means of treatment, hence the necessity is apparent of 
treating the inflammation in its early stages, modifying 
the character of the urine, and manifesting such energy 
as will cause a disappearance of the given lesions. The 
increase in the secretion of mucus by the bladder should 
be treated with two to four granules of arbutine four 
times daily, and five granules of the benzoate of soda 
four times daily. The use of revulsives, especially 
those of a caustic character, is not always attended with 
good results. If there is suppuration, two granules 
each of iodoform and arseniate of soda may be given 
three or four times daily, and the bladder may also be 
washed out either with simple warm water or weak so- 
lutions of nitrate of silver, tannin, etc. A catheter 
which will admit of a double current must be used, and 
the injection must be made with great care, to avoid 
dilating the bladder. If the products of ammoniacal 
decomposition of the urine are being absorbed through 
a more or less ulcerated mucous membrane, Sedlitz 
Chanteaud or some other saline laxative must be given, 
and means must be taken for prompt removal of the 
ammoniacal urine and careful cleansing of the bladder. 



ELEMENTS OF DOSIMETRIC PRACTICE. 



197 



Septicaemia resulting from decomposition of diseased 
tissues will also require the use of the same surgical 
means as the foregoing, while internally two granules 
of salicylate of quinine and salicylate of ammonia may 
be given every hour. Cantharidal cystitis, which- re- 
sults from the prolonged application of cantharidal 
vesicants, may be relieved by hyoscyamine and the 
bromide of camphor. Cystitis of rheumatic origin 
should be treated with colchicine. The paralytic form 
of cystitis, occurring in the aged, should be treated 
with three granules each of quassine and hypophosphite 
of strychnine at each meal. Alkaline and sulphurous 
mineral waters may be useful in all cases of chronic 
cystitis. Careful diet, frequent evacuation of the blad- 
der, and abstinence from alcoholic drinks and from 
irritating food are prescriptions which the physician 
should never fail to give, and the patient to follow in 
all cases of this disease. 



m 



Dominant. 



/ Acute cystitis 



j Inflammatory ele- 

\ ment . 

/ Fever . 
Periodicity . 
Radiating pains . 
Tenesmus 
Hyperesthesia 
Constipation . 



> 



Paralysis 



Rheumatic element 
Cantharidal elimi- 
nation 
Catarrhal secretion 
Purulent discharge 
Ammoniaemia 



Chronic cystitis { Septicaemia 
Paralysis 



Aconitine. 

Aconitine. 

Hydrobromate of quinine. 
Cicutine. 
Hyoscyamine. 
Bromide of camphor. 
Sedlitz Chanteaud. 
Hypophosphite of strych- 
nine. 
Colchicine. 

Hyoscyamine. 

Arbutine, benzoates. 
Iodoform,arseniate of soda. 
Saline purgatives. 
Salicylates of quinine and 

of ammonia. 
Quassine, hypophosphite 

of strychnine. 
Hydrotherapy. 



Cysts (Hydatid, of the Liver).— From the eggs of 
Tcenia ecMnococcus are produced cysticerci, which 
find a lodgment in different organs, but especially in 
the liver, where they multiply and form cysts which 
sometimes reach an enormous size. These cysts give 



198 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

rise to various troubles, and frequently cause death, 
either by opening into important organs, by causing 
purulent infection, or as a result of the haematopoietic 
disorders which are inseparable from disturbances in 
the functions of the liver. As a means of prophylaxis, 
one should not drink river- water, nor water which is 
likely to have flowed over or drained through fields in 
which animals which are subject to taenia have been 
kept. Boiled water is free from all danger of produc- 
ing this condition. Surgical treatment is almost always 
required, whether one operates by aspiration, by means 
of large openings, with injections of a one-per-cent so- 
lution of hydrate of chloral, or by electrolysis. But, 
whatever procedure be adopted, medical treatment 
should be tried to accomplish, if possible, the absorp- 
tion of the contents of the cyst, which is considered a 
lesser evil than the long period of suppuration which 
will follow either of the operations suggested. In the 
first place, iodoform should be given in doses of four to 
eight granules three times daily. , If the result of this 
treatment proves unsatisfactory, we should operate, 
opening the cyst with a large trocar, and completely 
evacuating it. Frequent injections should subsequent- 
ly be made, and a drainage-tube should be left in the 
wound. Surgical treatment should be attended with 
antiseptic precautions, and subsequent treatment should 
be tonic and antipyogenic, two granules each of iodo- 
form and of arseniate of soda being given three or four 
times daily, and two or three granules of arseniate of 
strychnine with each meal. Should fever follow the 
operation, one granule each of aconitine and arseniate 
of quinine should be given every half-hour until the 
fever abates. For other indications as to treatment, 
any of the classical works on therapeutics may be con- 
sulted. 

Delirium Tremens.— Life is, without doubt, the 
result of the struggle between stimulant agencies — 
either from without, and received by the peripheral 



ELEMENTS OF DOSIMETRIC PRACTICE. 199 

ends of the nerves, or from within, and received by the 
nervous centers and the splanchnic radiations ; and, on 
the other hand, individual impressionability, which re- 
sults from the impressionability peculiar to each ana^ 
tomical element. Life depends, therefore, upon the 
external and internal media appertaining to the indi- 
vidual, and upon his somatic constitution, which is 
animated ab ovo by a special force which is called vital 
force. Differences in life will result, therefore, per- 
haps from modifications in its media, perhaps from 
changes in impressionability, perhaps from both these 
causes combined. Gradual intoxications have only the 
effect of modifying the material constitution of the in- 
dividual by causing assimilation of substances foreign 
to its normal composition ; they also change the consti- 
tution of the blood, that internal medium, the troubles 
of which have much more importance than bad exter- 
nal conditions. They thus give origin to impressiona- 
bility of a new character, for the elements, being com- 
pelled to live in a modified medium, end by adapting 
themselves to that medium, in which their reactions 
are different from what they were originally. For a 
long time this adaptation will preserve the vital equi- 
librium, with all the appearances of health ; but, if the 
new stimulant to which the system has become habitu- 
ated suddenly fails, the entire equilibrium will be de- 
stroyed, because the adaptations are slow and progres- 
sive, and the vital acts can not be accomplished with 
the regularity and perfection which is observed in the 
case of individuals who are in a normal physiological 
condition. In a word, the organism accustomed to the 
exceptional finds itself in the presence of the regular, 
and in unusual conditions which disturb it profoundly. 
Such is the course of events in connection with alcohol- 
ism. Not only does the alcohol modify the tissues 
physically and chemically, it also modifies the blood- 
current, and mingles with the secretions, thus acting in 
a double manner upon impressionability. In fact, the 



200 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

sensibility, contractility, and irritability of alcohol- 
users are no longer the same as before their excesses 
began, and for that reason physiology, pathology, and 
therapeutics, as applied to such cases, are entirely dif- 
ferent from their application to sober and temperate 
people. In other respects the lesions which one finds 
in alcoholics are the same as those which are observed 
in pathological states due to other cause, and having 
the same anatomical situation. The treatment will 
therefore be the treatment which is proper for such 
lesions, aside from the removal of the cause. But it is 
not the same for functional lesions, the most of which 
are peculiar to alcoholism, and demand peculiar treat- 
ment. The functional perturbations arise from changes 
in the physiological condition, as has been already ex- 
plained, and neither require a long time nor are diffi- 
cult to cure, if one understands the treatment which 
should be adopted. It must be clearly understood 
that the least change in this artificial physiological con- 
dition necessitates decided disturbance of equilibrium, 
and may even be the cause of death, without the mani- 
festation of sufficient cause, from such a source, to ex- 
plain it. Sufficient cause for a sudden and unexpected 
attack of delirium tremens may be found in an increase 
in the elimination or a decrease in the dose of alcohol, 
in an exaggeration with respect to its combustion, an 
exaltation in the impressionability of the individual — 
in fact, in a cause which might, under ordinary circum- 
stances, seem insignificant. The duration of such an 
attack will depend upon the manner in which it is 
treated, and the different causative elements. All the 
causes which lead to want of equilibrium in such cases 
may, however, be reduced to two : diminution or increase 
of the habitual stimulant relatively to the impressiona- 
bility of the patient. These two modes of pathogenesis 
must be held in mind in arranging a plan of treatment, 
and one must be carefully distinguished from the other, 
the more because the problem of treatment is almost 



ELEMENTS OF DOSIMETRIC PRACTICE. 201 

always complicated. We should therefore consult the 
impressionability of the patient, incite it when de- 
pressed, or soothe it when exalted. Whatever be the 
customary dose of the stimulant, we must suppress it, 
for it is preferable to seek to restore the equilibrium by 
acting upon the vitality. If the absence of the stimu- 
lant causes disorder in the functions, we must use incit- 
ants ; if, on the other hand, the trouble is due to exces- 
sive use of the stimulant, we must restore calmness, 
either by inciting antagonistic functions or by weaken- 
ing synergical functions. Life being a struggle, a con- 
flict, the resultant of opposed and antagonistic forces, 
there are in all diseases two means of restoring the 
equilibrium of health : one, a direct method, consisting 
in an attempt to correct the disturbed functions imme- 
diately ; the other, an indirect one, by acting upon the 
functions which moderate or regulate the first. The 
form of treatment which is most in vogue for deli- 
rium tremens is that which was suggested by Jac- 
coud, and consists in the use of alcohol. If the 
attack is produced by the want of the habitual 
stimulant, or of any other stimulant which, with 
the habitual one, will establish the functional equi- 
librium, the results of this treatment are prompt and 
admirable. But if the quantity of the stimulant 
consumed is in excess, or, the dose of the stimulant 
remaining the same, the impressionability is exalted, 
alcohol as a means of treatment will do harm, and we 
should use in preference such calmatives as digitaline, 
aconitine, hyoscyamine, morphine, chloral, etc. But 
alcohol, even in cases in which good results may be 
expected, on account of its previous disuse as a stimu- 
lant, is a bad remedy, because it tends to perpetuate 
chronic alcoholism, and may cause the repetition of 
acute paroxysms. Besides, it has the great disadvan- 
tage of being opposed to reformatory steps on the part 
of the patient, for, if alcohol serves to cure alcoholism, 
it ought to be still more useful as a means of prevent- 



202 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

ing it. With such treatment the patient has no oppor- 
tunity to cure himself of his bad habits, and be enabled 
to live without using alcohol. JSfo thing can equal 
strychnine in the treatment of this condition. Aside 
from the fact that it is superior to alcohol as an incit- 
ant, it also gives better results. It was first recom- 
mended by Falck Wunderlich and then by Luton. 
Recently it has been used with considerable audacity 
by Lardier, who seems to have borrowed his method 
of administration from the dosimetric system. He has 
obtained the best results without running any risk. 
The doses should be very large, and should be repeated 
at short intervals. Three to five granules at a dose may 
be given every half -hour or hour until an effect is pro- 
duced upon the insomnia and the condition of the 
pupils. Strychnine is not suitable for all cases, how- 
ever, and should not be administered alone. Often, in 
place of cerebral asthenia, one meets with a hyper- 
sthenic condition in delirium tremens, or these two 
conditions may co- exist in different parts of the nerv- 
ous system — a condition which requires the use of 
hyoscy amine until the physiological effect is indicated 
by the condition of the pupils and pulse. The follow- 
ing case demonstrates the fact that we must not use 
the same remedy for all cases, nor even for all phases 
of the disease in the same individual : F was sud- 
denly stricken in the street with apoplexy, and was 
borne to his house in an unconscious condition. He 
revived after a short time, but was excessively agitated, 
delirious, and wakeful ; his countenance was red, his 
pupils were dilated, his pulse full. Three granules of 
arseniate of strychnine hourly were prescribed until he 
should become quiet or go to sleep. The next day he 
was much more tranquil ; he had slept well, and his 
pupils were normal in appearance, but his delirium, 
though less intense, continued. The strychnine was 
persisted in on account of the previous good results. 
His next night was a bad one, and on the following 



ELEMENTS OF DOSIMETRIC PRACTICE. 203 

morning his delirium was more intense, and had 
changed its character ; the pupils were excessively con- 
tracted, the pulse was hard, and the countenance pale. 
Under these circumstances, hyoscyamine was substi- 
tuted for the strychnine. One granule every three hours 
restored the patient in twenty-four hours, excepting a 
general weakness, which lasted a long time, and which 
was due to the want of alcohol, from which the patient 
abstained as long as he was confined to his bed. He 
was thus under the best conditions for recovery, for 
abstinence for a month is sufficient for one of good will- 
power to overcome a habit which is as blameworthy as 
it is harmful. 

gg/Do— \*ssst of the 

O !=! I / Want of stimulant . . . Strychnine. 

Increase of impressionability . Hyoscyamine. 

Sthenic condition of the circula- ) -n- -, i- „„ •■• „ 

, • - Digitalme, aconitine. 



3« 



Variant. / 



Insomnia from want of stimu- / "Mornhine 

lant < 

Insomnia from excess of stimu- ) 

lant or increase of impression- V Codeine, narceine. 

ability ) 



Dermatoses. — The study of diseases of the skin 
ought to be placed upon new foundations. All the 
classifications which have thus far been presented 
have the fault of overlooking the vital nature of 
the different lesions, and attributing importance only 
to organic lesions, those which are apparent and su- 
perficial. This fault is especially perceptible in its 
application to the subject of treatment. The Vienna 
school goes even further, and pretends to isolate the 
affected portion from the rest of the organism, but the 
facts do not cease to protest against this localism. The 
result of these artificial classifications, which attach 
to themselves scarcely any of the important elements 
of the diseases, is to reduce the therapeutics of this de- 
partment to a chaos of empirical formulas and remedies, 
to apply to the same lesions different preparations, the 
pharmacodynamics of which often differs, and is some- 



204: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

times antagonistic, and to prescribe almost always the 
same treatment for all diseases. Cutaneous diseases 
ought to be divided into two great classes, leaving aside 
those in which the eruption is only a secondary symptom 
of a general disease — for example, the eruptive fevers, 
purpura, etc. The first group includes diseases which 
consist in the irritation of the cutaneous tissues pro- 
duced by the presence of parasites, as in scabies, favus, 
etc. The second should include those which proceed 
from a lesion of the vitality — that is, from a fault in 
the innervation, whether of excess or perversion. These 
functional troubles lead to disorders of nutrition and 
circulation, which in their turn cause organic difficul- 
ties, which are manifested externally by the different 
dermatoses. Modifications of the secretions, which are 
the essential features of the diatheses, cause dynamic 
troubles in the nervous expansions, which are trans- 
formed into lesions which are localized in the regions 
where a supplementary cause of irritation exists, or 
some difference in vitality limited to a small number 
of nerve filaments. The dominant in the dermatoses 
should vary, therefore, with the dynamic cause which 
produces it. If the irritation is caused by parasites, 
we must eliminate the cause with sulphide of calcium 
and the most appropriate local treatment ; if the trouble 
arises from a want of innervation, we must give strych- 
nine and phosphoric acid ; if, on the other hand, the 
irritation reveals an exaggeration of the phenomena of 
nutrition, we should give aconitine or vera trine. For 
the diathetic dermatoses, the treatment which is fun- 
damental for each diathesis is proper — that is, mercury 
for syphilitic, the arseniates for the herpetic, colchicine 
for the arthritic, iodoform or sulphide of calcium for 
the scrofulous. In the treatment of diseases of the 
skin, we should be less influenced by the outward form 
of the lesions than by the principal morbid element 
which characterizes them. In eczema, in many cases 
of acne, in herpes, sycosis, etc., that which excites at- 



ELEMENTS OF DOSIMETRIC PRACTICE. 205 

tention is the congested condition, the phlogosis of the 
skin. Eight to twelve granules of veratrine daily will 
be found effective in these cases, because by its de- 
pressant action it destroys the principal morbid ele- 
ment of the disease. In the active forms of hyperemia, 
like erythema, etc., aconitine will prove effective on 
account of its ansemiating properties. Two granules 
may be given for this purpose three or four times daily. 
Pemphigus, rupia, and ecthyma, which are the outward 
evidences of great vital depression, call for the use of 
the arseniate of iron and the hypophosphite of strych- 
nine. Two granules of each may be given four times 
daily. Those affections which are characterized by 
dryness of the skin, especially the squamous affections 
like psoriasis, icthyosis, etc., indicate defective nutri- 
tion in the epithelial tissue, which may be corrected by 
the arseniates, and especially by arsenious acid, six to ten 
granules of which may be given daily. Those diseases 
which are accompanied by pruritus or neuralgia, like 
zona and prurigo, should be treated by calmative agents 
to the nervous system, especially by cicutine, two gran- 
ules of which may be given four or five times daily. 
The method of treatment will be governed by the time 
that the disease has lasted, or, in other w^ords, by the 
degree of resistance which is opposed to the remedies 
used. Thus, an exudative eczema which has lasted 
only a few days can be cut short by active treatment 
with veratrine, one granule of which should be given 
every quarter of an hour, while the dry forms of eczema 
will be controlled by sulphide of calcium, one granule 
being required every half-hour. The activity with 
which medication is carried out has a decided bearing 
upon the duration of a disease of this kind. Timid 
treatment serves only to prolong the disease indefinite- 
ly, and compels the physician to be constantly chang- 
ing his remedies w T ith no advantage to any one. A re- 
cently observed case has convinced the author of the 
necessity of observing these principles, which are the 



206 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

exact principles of dosimetry. The case was that of a 
child fourteen months old, who was suffering with 
eczema of the face, for which six granules of sulphide 
of calcium daily had been ordered. At the end of three 
weeks there had only been slight improvement. At 
that time the child was attacked with croup, for which 
one granule of sulphide of calcium was ordered hourly, 
this being continued for two days. At the end of that 
period the eczema had entirely disappeared. Thus two 
days of active treatment produced more effect than the 
previous three weeks of insufficient dosage. It is neces- 
sary to avoid gastric intolerance, and all other bad re- 
sults which would compel us to interrupt the treat- 
ment ; but we should not hesitate to give doses which 
are sufficiently large, because in this way much time 
will be gained, and many complications and annoy- 
ances may be avoided. The local treatment should 
amount to very little. It may consist of simple baths, 
to assist in removing the exudate ; of pure vaseline, to 
prevent contact with the air and the deposit of sub- 
stances which are suspended in the air ; of starch, on 
account of its absorbing and refreshing qualities ; of 
vaseline and calomel, or precipitated sulphur (ten per 
cent), for parasites which are accessible by external 
means. The use of irritating substances must be rigidly 
avoided, at least in those forms in which they produce 
active irritation. 



f Parasites 
I Herpetic diathesis 
'Dominant. \ Syphilis . 

Arthritic diathesis 

Scrofula 

Hyperaemia . 

Phlogosis 

Atony . 

Anaemia 
\ Variant. ( Pains 

Pruritus 

Epithelial hyperpl 

\ Ulcerations . 



Sulphide of calcium. 

Arseniate of soda. 

Biniodide of mercury. 

Colchicine. 

Iodoform. 

Aconitine. 

Veratrine. 

Strychnine. 

Arseniate of iron. 

Cicutine, morphine. 

Gelsemine, hydrobromate of 

cicutine. 
Arsenious acid. 
Hypophosphite of strychnine. 
Phosphoric acid. 



ELEMENTS OF DOSIMETRIC PRACTICE. 207 

Diabetes. — More than fifty theories have been ad- 
vanced to explain the pathogenesis of diabetes, which 
is equivalent to saying that there are at least fifty 
causes for it. This superfluity of hypotheses also indi- 
cates our ignorance as to the exact nature of glycosuria, 
and the mechanism by which one passes from health 
to diabetes. The theories which are based upon experi- 
mental physiology and pathology are not relevant to 
the question, for it is impossible to compare artificial 
glycosuria with diabetes, just as one can draw no con- 
clusions from albuminuria in respect to Bright' s disease. 
In every case glycosuria is unquestionably a constitu- 
tional disease, characterized essentially by a grave dis- 
turbance of the nutritive functions which will not lend 
themselves for the assimilation of glucose, or else trans- 
form into glucose the principal elements of the organ- 
ism. The nervous system, which presides over acts of 
nutrition, preponderates among the agents which inter- 
vene to produce diabetes, and the efforts of therapeu- 
tics should converge mainly in the direction of trophic 
innervation. Want of equilibrium in the nutritive 
functions should be corrected in three ways : (1) by 
furnishing to the blood all the materials capable of im- 
proving its constitution ; (2) by exciting, through the 
influence of the nervous system, the functions of assimi- 
lation ; (3) by stimulating the digestive functions to 
activity, in such manner as to furnish for assimilation 
an abundance of well-elaborated material. The first 
indication should be filled with the arseniates of soda, 
potassium, and iron, two or three granules of each 
being given three times daily ; the second, with the 
arseniate of strychnine and phosphoric acid, two gran- 
ules being given three times daily ; and the third, by 
quassine and pepsin, two to three granules with each 
meal. Saccharine and starchy articles of food should 
be abstained from as far as possible, so as to avoid 
aggravating the kidneys by the frequent passage of a 
thickened and abnormal urine. But to completely 



208 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

abandon starchy foods in order that by this means the 
patient may excrete less sugar, to run the risk of 
gravely disturbing the digestive functions and thus 
rapidly weaken the patient, a thing which is to be stu- 
diously avoided in all chronic diseases, but especially 
in those which quickly affect the nutrition, appears to 
the author to be a serious mistake, a confounding of 
glycosuria with diabetes, and a vain attempt to cure a 
disease by diminishing the intensity of a single one of 
its symptoms. It is like attempting to cure a cirrhosis 
of the liver by diminishing the quantity of fluids in- 
gested, and thus expecting to relieve the ascites. It is 
believed that many cases of diabetes get well spontane- 
ously, and also that the facility and frequency with 
which we discoyer glycosuria by examination of the 
urine have had the singular result of diminishing the 
gravity of the prognosis, and of attributing to hygienic 
treatment an efficiency which it does not really possess. 
In the days when diabetes was recognized only at a peri- 
od in which the condition was a very bad one, recoveries 
never occurred ; now, when one finds it in individuals 
who present every appearance of health, the disease is 
considered curable, and this fortunate result is attrib- 
uted to the suspension of glycogenic substances. When 
the patient can no longer endure the rigid diet which is 
imposed upon him, an infraction of it does not seem to 
do him any harm. The glycosuria increases, it is true, in 
proportion to the quantity of sugar ingested, but the 
disease itself is not intensified thereby. Followers of 
the doctrines of Bouchardat ought for the same reasons 
to seek to cure diabetes by devoting their attention 
only to the relief of the polyuria, and to accomplish this 
they need only abolish water from the regimen. The 
patient would pass a much smaller quantity of urine, 
but the deprivation of fluids would only increase his 
sufferings. The variant in diabetes is unfortunately 
very limited. The complications are especially sec- 
ondary diseases which appear during the period of 



ELEMENTS OF DOSIMETRIC PRACTICE. 209 

gravity, and consequently yield with difficulty to a 
symptomatic treatment. The polydipsia may be re- 
lieved by codeine, three to five granules being given 
between meals. The polyuria is correlative with the 
polydipsia ; the less the patient drinks the less he 
urinates, and the less also he suffers from the erup- 
tions which ordinarily involve the external genital 
organs in this disease. The polyphagia may be satis- 
fied as far as the digestive powers of the patient will 
permit. If the appetite is exceedingly voracious, we 
should use one to two granules of hyoscyamine two 
hours before each meal. Vomiting and diarrhoea 
should be treated, aside from precautions as to diet, by 
the hydrochlorate of morphine and brucine, two to 
three granules being given every three hours. For the 
constipation three to five granules of podophyllin 
should be given before retiring. Impotence rarely dis- 
appears until a favorable modification of the disease 
takes place. This is one of the symptoms for which the 
patient insists upon relief more earnestly than for any 
other, and should be treated with neurosthenics, espe- 
cially with the arseniate of strychnine, two or three 
granules being given three times daily. The cutaneous 
eruptions, furuncles, erysipelas, anthrax, etc., should 
be treated with two granules of sulphide of calcium 
every two hours, and during suppuration, by two 
granules each of iodoform and arseniate of sodium, 
three or four times daily. The visceral inflammations, 
the most frequent of which are bronchitis and pneu- 
monia, are always of grave significance, because they 
are frequently terminated by gangrene. The use of 
tonics should be insisted upon, especially the hypophos- 
phite of strychnine, and the antiseptics, the salicylates 
of ammonia and quinine, and iodoform — two granules of 
each may be given every hour. We should make care- 
ful inquiry with respect to the diatheses which have 
been able to beget this disease, for by recognizing them 
important therapeutic results may be obtained. The 

14 



210 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



general diseases which most frequently give rise to 
glycosuria are syphilis, malaria, and arthritis. For 
the syphilitic infection we should give five to fifteen 
granules of the protiodide of mercury daily, watching 
their effects in order to avoid mercurial salivation, 
which would be most undesirable. Malarial poisoning 
should be treated with the arseniate and salicylate of 
quinine, and arsenious acid — five to ten granules of the 
first with two of the second being given two or three 
times daily. The arthritic diathesis, which is one of 
the most common of the predisposing causes, calls for 
colchicine and the arseniate of soda, two granules of 
each being given two or three times daily. 



f Impairment of nutrition 

('Dominant. \ Depression of the nerv- 
ous system 
Dyspepsia . 

Glycosuria . 

Polyuria 
Polydipsia . 
Polyphagia . 
Constipation 
Diarrhoea 
Vomiting 
K Variant. ( Impotence . 

Visceral inflammations 

Gangrene 

Arthritic diathesis 

Malarial poisoning 

\Syphilis 



Arseniates of sodium, potassi- 
um, and iron. 

Arseniate of strychnine, phos- 
phoric acid. 

Quassine, pepsin. 

Benzoate and salicylate of am- 
monia. 

Codeine. 

Hyoscyamine. 
Podophyllin. 

Hydrochlorate of morphine. 

Arseniate of strychnine. 

Sulphide of calcium. 

Salicylates, iodoform. 

Colchicine, arseniate of sodium. 
Arseniate and salicylate of qui- 
nine. 
Protiodide of mercury. 



Diarrhoea. — This symptom, while it may be studied 
in all the diseases in which it is present, yet deserves 
particular attention, especially in relation to its causes. 
One of the most frequent causes is the imperfect elab- 
oration of the food, whether on account of excess as to 
its quantity or quality, or the accentuated influence of 
dyspeptic conditions. Want of food may also cause 
diarrhoea. 

Diarrhoea a crapula is cured by abstinence; diar- 



ELEMENTS OF DOSIMETRIC PRACTICE. 211 

rhcea in consequence of dyspepsia calls for appropriate 
treatment, the basis of which should be pepsin, two or 
three granules four times daily. Sedlitz Chanteaud in 
small doses will regulate the intestinal functions, and 
cause the evacuation of any undigested material which 
the intestines may contain. In other cases the diarrhoea 
is due to an excess of bile. Sedlitz Chanteaud, or mild 
cholagogues, by exciting the liver to disgorgement, will 
diminish the flow of bile, and thus destroy the efficient 
cause of the diarrhoea. In such cases we should give 
two granules of hydras tine three or four times daily, or 
euonymine in similar quantities. One of the most com- 
mon causes of diarrhoea is vaso-motor paralysis, and 
the latter gives rise to this symptom in many diseases. 
A chill, a moral emotion, may be enough to excite it. 
This theory as to pathogenesis is confirmed by experi- 
mental physiology. If the nerves which are distributed 
to a limited portion of the intestine are cut, in a few 
hours this isolated portion will be filled with serum. 
Many varieties of congestion and inflammation have 
the same origin. In cases of simple paralysis of the 
nerves, one should give three granules of brucine every 
two hours, or two granules of the sulphate of strych- 
nine every two hours. Should the inflammatory ele- 
ment complicate the vaso-motor trouble, it would be 
proper to add a granule of aconitine every two hours. 
Three granules of morphine every two hours, or two of 
narceine every hour, will also be of service, if there is 
pain in connection with the diarrhoea. The diarrhoea! 
flow will be checked much more quickly if these two 
varieties of agents are combined. The passive conges- 
tions which are caused by interference with the portal 
circulation can be treated with less certainty of a cure 
on account of the permanence of the cause. The means 
which may be used with more confidence than any 
others are Sedlitz Chanteaud, to relieve the engorged 
mucous membrane, by exciting a serous discharge ; 
strychnine, to increase the vaso-motor tonicity ; and re- 



212 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

vulsives, which, may be frequently repeated. The latter 
means have frequently given excellent results, both in 
cases of this kind and also in cases of chronic diar- 
rhoea ; they may be applied over different portions of 
the abdomen. Vesicants and the actual cautery, in 
points or in transcurrent lines, will prove very valuable 
in many cases which have resisted other forms of medi- 
cation. These methods must be used with care and 
persistence, however, in order to obtain the desired 
results. The intestinal mucous membrane, which is 
also a very active organ of elimination, often suffers 
because this function is exaggerated or perverted, by 
reason of the nature of the substances which it is com- 
pelled to excrete. It is in this way that miasmatic 
infection produces diarrhoea, which can be effectively 
checked only by the use of sulphate of quinine, two 
granules of which may be given three or four times 
daily. The elimination of animal matter which has 
undergone decomposition and then absorption also 
takes place by way of the intestinal mucous membrane. 
For such a case one should prescribe three granules of 
the salicylate of quinine every two hours, for its anti- 
septic effects. The deterioration of the constituents of 
the blood, which gives rise to the various diatheses, is 
also the source of a similar elimination, which, by irri- 
tating the mucous membrane, also excites diarrhoea. 
The arthritic and the herpetic diatheses are the ones 
which most frequently give rise to this condition. In 
the herpetic diathesis we should give two granules of 
the arseniate of strychnine four times daily, and in 
the arthritic a similar quantity of the benzoate of 
soda. In all cases we should also give Sedlitz Chan- 
teaud, which, by facilitating the intestinal and renal 
elimination, will aid in restoring the secretions to their 
normal condition. Excessive peristaltic motion may 
also cause diarrhoea, by the hasty manner in which its 
contents are propelled through the intestine. For such 
cases one granule of hyoscy amine or sulphate of atro- 



ELEMENTS OF DOSIMETRIC PRACTICE. 213 

pine, every three hours, may produce a cure after other 
means have failed, by regulating the contractile power. 
Diarrhoea may also be excited by the presence of para- 
sites. Such appears to be the origin of the form of 
diarrhoea which is prevalent in Cochin China. It is 
also sometimes seen as an apyretic disease among chil- 
dren, which fails to respond to ordinary treatment, but 
yields to santonine, five granules of which may be used 
three or four times daily. Diarrhoea in children, when 
it assumes the violent form known as cholera infantum, 
calls for energetic and immediate treatment, provided 
that the vital forces are not entirely prostrated, for in 
such a case all treatment would be useless. We need 
not hesitate to administer morphine to children, if the 
dosimetric system of treatment be followed. One half 
or one third of a granule may be given every two or 
three hours, until the therapeutic or physiological effect 
is obtained. After this effect has been produced, and 
in case the child becomes sleepy before the diarrhoea 
has been checked, we must seek to dissipate the nar- 
cotic effect by giving a granule of brucine or of tannic 
acid every three hours. The diarrhoea of nursing chil- 
dren is almost always dependent upon improper ali- 
mentation. Hygienic methods are the best, both for 
preventing the disease and its recurrence ; but any in- 
testinal derangement whatever in children of such a 
tender age must be checked at the beginning, for a dis- 
order which is apparently not severe may quickly lead 
to a fatal termination. The regular school of practice 
has an arsenal with a variety of instruments for the 
treatment of diarrhoea ; but the quantity of its arms is 
far from compensatory for their quality. Most of its 
successes are only apparent. The subnitrate of bis- 
muth, the pulverized preparations of lime, the absorb- 
ents in general, are limited to an absorbent action upon 
liquid exudations, which remain, on account of this 
change in the consistency, at the entrance of the large 
intestine. If the treatment be interrupted, supposing 



214 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

that a cure has not taken place spontaneously, the 
diarrhoea will reappear, because, in reality, it has never 
been cured. Remedies which do not act upon the vital- 
ity are always uncertain ones. Almost the same state- 
ments may be made concerning astringents. They act 
in two ways : chemically, by coagulating the albumen of 
the intestinal contents, which are thus made less fluid 
in consistency, and are more easily retained; vitally, by 
causing contraction of the tissues, the impression being 
communicated to the nervous centers, from which it is 
sent away transformed into an increase of tonicity. 
Unfortunately, tannic acid and substances which con- 
tain it can not be used for very long periods, because 
they modify the composition of the tissues and the se- 
cretions. The perchloride of iron has given the author 
excellent results in diarrhoea, and in cases, too, in which 
other remedies had been tried in vain, like tannin ; 
however, it should be used only in acute affections, for 
its prolonged use might do harm. The anexosmotics 
are of greater utility ; but we should give up the com- 
plex preparations of these substances which are on the 
market, as they contain inconstant quantities of the 
active substance, and include, in addition, other sub- 
stances which have an opposite action, or an action 
which offers some inconveniences. Thus, diascordium 
(of the Parisian Codex) not only varies on account of 
the uncertain composition of the opium which it con- 
tains, but also by the chemical combinations which the 
tannin of several of its component parts forms with its 
alkaloids. Laudanum, which includes such variable 
proportions of morphine, is measured by drops, the 
weight of which is also very uncertain. It is therefore 
not astonishing that so much fear is manifested in ad- 
ministering these drugs to young children, who are 
very sensitive, it is true, to the action of certain drugs, 
but who are governed, nevertheless, by the ordinary 
rules of vitality. Poisonous effects among them are 
attributed to differences in the doses of the active prin- 



ELEMENTS OF DOSIMETRIC PRACTICE. 215 

ciple— differences which are perceptible to a less degree 

in large quantities of the remedy than in small ones. 

While the activity of morphine may be greater than of 

opium, it is far less dangerous to use such a substance, 

which is always identical and may always be measured 

with exactness, than another which varies constantly 

in its activity, and always leaves us uncertain whether 

we have given too much or not enough, for it is only 

by chance that we give just the necessary quantity 

of it. 

DIARRHCEA. 

From excess or bad quality j Food . . Pepsin. 

of substances ( Biliary matters Sedlitz Chanteaud. 

-T7- . , -. i I Nervous . . Brucine, strychnine. 

Vaso-motor troubles . . j Inflammatorv Aconitine, codeine. 

( Sedlitz. 
From passive congestion . . . . -j Brucine. 

( Revulsives. 
uti^v, +t,« i««*4-«««« f Miasmatic . . . Sulphate of quinine. 
° <2i * mt ^ T J Decomposed . . Salicylate of quinine. 

asi&ssti-l r petic A -- teof strych ", 

( Arthritic Benzoate of soda. J 

From exaggerated contractility . . . Ilyoscyamine. 
From parasites Santonine. 

Diphtheria (Diplitheritic Diseases, Croup, Pseudo- 
membranous Angina). — Diphtheria may arise in two 
ways : there may be a general infection of the organ- 
ism by the micrococcus of diphtheria, with subsequent 
localizations ; or the infection may be local primarily, 
two conditions presenting themselves — by the first, the 
disease remains more or less localized, the microbes 
failing to infect the entire organism, owing to the ab- 
sence of receptivity on the part of the organism ; by 
the second, receptivity exists or is subsequently estab- 
lished, and the local disease becomes general. 

The primary general infection is always the most 
dangerous, because the vitality of the entire economy 
is attacked ; the purely local infection may be consid- 
ered benign, because it gives us time to put the organ- 
ism in a state of defense against its general diffusion. 
In both cases the dominant consists in the modification 



216 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

of the organism in such a way that it shall be an un- 
suitable medium for the cultivation of micrococci. The 
general treatment is the most important, and for that 
reason we should not hesitate to administer the sul- 
phide of calcium upon the least suspicion of the inva- 
sion of the system by diphtheria. The excellence of 
the results will depend especially upon the opportune- 
ness and the energy of the treatment. Opportuneness 
will consist in attacking the disease as soon as it ap- 
pears ; energy will consist in the regular administra- 
tion of the proper doses until a result has been obtained. 
One granule of the sulphide of calcium every quarter 
of an hour, for infants ; or two at a dose for young 
children, given with regularity and perseverance until 
a positive result is obtained. This is the only way to 
neutralize the infection after it has been accomplished, 
or is about to be accomplished. 

When the patient begins to exhale sulphureted 
hydrogen, the medicine may be given once an hour for 
several hours ; after which, the symptoms of sulphuric 
saturation having diminished, the former dosage may 
be resumed. In giving this medicine to children the 
granules may be powdered, and then placed on the 
child's tongue with the fingers, or with the end of a 
spoon. Sometimes a little sugar or a little milk must 
also be given. Whatever be the method of adminis- 
tration, it will not usually be found difficult to give 
this drug to children. In doses of one granule every 
quarter of an hour it is very well tolerated for two or 
three days. The child may take nourishment, and 
may sleep, without interrupting the regularity of the 
treatment. But we should not fear to awaken him if 
necessary, for success depends upon regularity in the 
treatment. Whether diphtheria be localized in the 
pharynx, upon the mucous membrane of the bladder, 
or upon any portion of the tegumentary surface, the 
fundamental treatment should always be the same — 
the sulphide of calcium. It will sometimes happen 



ELEMENTS OF DOSIMETRIC PRACTICE. 217 

that the infection may be so pronounced, or that medi- 
cal intervention may occur so late, that it will not be 
possible to save the patient. This is no reason for 
casting reproach npon the method of treatment, for no 
better result would have been attained by any other. 
We are indebted to Dr. Fontaine for the introduction 
of this excellent microbicide into dosimetric therapeu- 
tics. The clinical results of this treatment which have 
been obtained in all countries constantly tend to estab- 
lish the renown which the future has in store for him. 
False membranes being a center for diphtheritic mi- 
crobes, it is most important that they should be removed 
and destroyed, especially when the infection is no longer 
localized. Topical applications are of especial value for 
this purpose, and two are recommended, the properties 
of which are well established by the results of experi- 
ence. They are pure lemon-juice and a five-per-cent so- 
lution of lactic acid, and they are the only ones which 
it is proper to use. Repeated applications with these 
substances should be made at short intervals, by means 
of a forceps or a small sponge attached to a long rod. 
In croup and pseudo-membranous angina it is some- 
times necessary to give an emetic, in order to displace 
and expel the obstructing false membranes. 

Sulphide of calcium will tend to break them up, and 
the topical applications to dissolve them ; but, aside 
from this action, especially in croup, it is absolutely 
necessary in certain cases to excite vomiting in order to 
effect the complete expulsion of the membranes. This 
is only an exceptional means of treatment, however, 
and it would be bad practice to use it generally. In 
order that the emetics may have good effect the mem- 
branes must be partly detached from the tissues which 
they cover, otherwise the vomiting must be repeated, 
at the cost of great fatigue to the patient. If the emetic 
fails to produce vomiting the effect is even worse, for 
in that case, being absorbed, it tends to aggravate the 
collapse into which the patient has fallen. For an 



218 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

emetic, three granules of emetine, dissolved in a tea- 
spoonful of warm water, may be given every five min- 
utes until the desired result is obtained. To assist in 
producing the effect the palate may be tickled, or we 
may give, in addition, one granule of emetic, also at 
intervals of five minutes. These means should be used 
with great caution, and only in those cases in which 
their use is clearly indicated. 

Spasm of the muscles of the glottis is sometimes the 
principal cause of the dyspnoea. In such cases we 
should give half a granule or a granule of hyoscy amine 
every half-hour, regulating its administration by the 
state of the pupils — that is to say, suspending it when 
the iris is well dilated. Paralysis of the muscles of the 
glottis calls for one granule of brucine every hour, in 
the less acute cases, or every quarter of an hour, if a 
very prompt effect is desired. Adynamia, which may 
be so quickly established, especially if emetics have 
been injudiciously used, may be treated with one gran- 
ule of brucine every two hours. For children over three 
years of age arseniate of strychnine may be substituted 
for the brucine. When asphyxia is imminent, as a last 
resort for improving the respiration, tracheotomy must 
be performed. The result is always doubtful, but it 
may bring relief. The paralyses which follow the dis- 
ease may be treated with two to six granules of the 
hypophosphite of strychnine daily, according to the 
age of the child. The fever may be almost neglected, 
as an element of secondary importance in this disease. 
It is usually neither very high nor of sufficiently long 
duration to greatly enfeeble the patient. It is better to 
concentrate one's entire attention upon the infective 
element of the disease ; besides, a defervescent action 
accompanies the effect of the parasiticide. Should the 
temperature reach 40° C, we may give three granules 
of veratrine every half -hour, if we wish to obtain an 
emetic effect, or one granule if we seek only the anti- 
thermic effect. Two granules of the hydroferrocyanate 



ELEMENTS OF DOSIMETRIC PRACTICE. 219 

of quinine may be given every half -hour, if the febrile 
movement should proceed by intermittent paroxysms. 



[^H^^SLc.is : | Sulphide of ca,ciu m . 

i Topical solvents. 
( Obstruction by membranes . < Emetic. 

( Emetine. 
Spasm of the glottic muscles Hyoscyamine. 
Paralysis of the glottic mus- ) Brucine> 

Adynamia .... Arseniate of strychnine. 
Imminent asphyxia . . Tracheotomy. 
Fever ■! ^ on tinued • Veratrine. 

* 1 Intermittent j Hydroferrocyanate of qui- 

Subsequent paralyses . . \ Hypophosphite of strycli- 



\ Variant. 



nine. 



Disease, Addison's. — Jaccoud announces the path- 
ogenesis of Addison's disease in the following manner : 
"Pathological anatomy and pathogenic interpretation 
make it evident that the clinical phenomena of Addi- 
son's disease take their point of departure from an 
abnormal excitation of the abdominal sympathetic 
plexuses, the semilunar ganglia, and the trophic nerves 
which originate there. This excitation is the result of 
a morbid process which is anatomically appreciable, 
which may involve the suprarenal capsules, under the 
form of a sclerosis or a caseous inflammation ; or the 
semilunar ganglia under the form of sclerosis, an essen- 
tially irritative process. According to its initial center 
we have, as a result of the excitation, which acts by 
radiation and by reflex action, gastric, hypochondriac, 
intestinal, or lumbar pains, vomiting, nausea (the gas- 
tric, hepatic, or mesenteric plexuses being involved), 
palpitations, and syncope (from the involvement of the 
semilunar and thoracic ganglia) ; and, since the sympa- 
thetic draws its activity from the cerebro-spinal center, 
incessant calls of this character, to keep up the abnor- 
mal state of excitation, break down the central appa- 
ratus, and diminish the activity of the functions which 
are dependent upon it. From this results the profound 
asthenia, which is inevitably fatal, notwithstanding the 



220 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

absence of any notable emaciation. With regard to the 
dark color of the skin in this, disease — the melanodermia, 
as it is appropriately called — it shonld not be attributed 
to an alteration of the pigment in the blood ; it is due 
rather to a hypergenesis, to a pigmentary change which 
is caused by excitation of the trophic nerves. 

The indication for the dominant is, therefore, to at- 
tack the principal dynamic lesion — i. e., the nervous 
excitation — and the most important material lesion, 
which consists in the trophic modifications of the supra- 
renal capsules, the nervous ganglia, and the nerves 
themselves, which have undergone degeneration. With 
one granule of hyoscyamine every three hours, com- 
bined with three of iodoform, this double indication may 
be filled. The asthenia which results from this constant 
excitation is the manifestation of the want of equilib- 
rium in the vital motion. In order to supplement the 
deficient vitality of the cerebro-spinal system, we should 
give two granules of the arseniate of strychnine or of 
phosphoric acid every two hours. The lipothymia and 
syncopes, which are the result of nervous asystole, or 
of fatty degeneration, call for caffeine or guaranine, dy- 
namophoric substances, which act as a tonic without 
producing excitement. Three granules may be used 
every quarter of an hour until an effect is produced. 

If the nausea and vomiting do not yield to the action 
of the dominant, quassine may be given in two-granule 
doses every half-hour. Epigastralgia and lumbo-ab- 
dominal pains may be assuaged by the hydrobromate 
of cicutine, the tannate of cannabine, or croton chloral, 
three granules to be given every quarter of an hour 
until a sedative effect is obtained. The melanodermia, 
by which the skin, however white it may be naturally, 
is colored as dark as that of a mulatto, may be treated 
with arsenious acid, care being taken that the pigment- 
ary hypergenesis be not increased by the efforts to di- 
minish it. Two granules of it may be given three to 
five times daily. 



ELEMENTS OF DOSIMETRIC PRACTICE. 



221 



Dominant. 



Variant. 



Excitation of the abdom- 
inal sympathetic plex 
uses 

Asthenia . 

Lipothymia 

Vomiting . 

Epigastralgia 

Lumbo-abdominal pains 

Melanodermia . 



Hyoscyamine, iodoform. 

Arseniate of strychnine. 
Caffeine, guaranine. 
Quassine. 

I Hydrobromate of cicutine. 

Arsenious acid. 

Diseases, Tuberculous. — Little can be said in re- 
gard to the means of combating this class of diseases. 
Their pathogenesis is still uncertain, notwithstanding 
the discovery of Koch's bacillus. It is difficult to be- 
lieve that in hereditary phthisis, for example, the germ 
is preserved in a lethargic condition for fifteen, twenty, 
thirty, or more years, being perfectly tolerated by the 
organism until certain particular conditions suddenly 
excite it to fatal activity. It is easy enough to believe 
that the bacillus is capable of producing tuberculosis, 
and to admit that local forms of tuberculosis have no 
other origin ; but, with respect to pulmonary phthisis, 
it would appear that there must be a precedent disease 
of the lungs in order that the bacillus might develop — 
an atonic condition of the pneumogastric nerve, which 
should constitute more than a simple predisposition, 
and should become a true hyposthenic neurosis. At 
least such would seem to be the condition in the ma- 
jority of cases. The constitutional weakness, greatest 
in the organs of least resistance, produces a diminution 
in the energy of the trophic functions. Then the first 
period of phthisis is established — the period of pulmo- 
nary adynamia. It may be that, at this time, the bacilli, 
finding a soil which is suitable for their germination, 
attack the respiratory organs, and become the principal 
cause of different symptoms, aiding in hastening the 
progress of the disease. It is not an agreeable thing 
to admit, however, that the bacilli find material for 
their nourishment and development in the lungs, the 
vitality of which is unimpaired. For this reason pre- 
disposition should receive the first place among the 
efficient causes, infection from bacilli being placed sec- 



222 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

ond. The dominant should, therefore, consist in the 
use of the most powerful neurosthenic agents, both of 
a hygienic and a pharmaceutical character. Under 
the first of these heads may be mentioned superali- 
mentation, a cold, dry climate, gymnastics, hydrother- 
apy, etc. ; among the second, the arseniate of strych- 
nine and phosphoric acid, or arsenious acid and the 
hypophosphite of strychnine. By alternating the two 
latter combinations, we may avoid the inconveniences 
which attend the too prolonged use of the same medica- 
ments, for it must be realized that this treatment should 
be followed up with perseverance and without inter- 
ruption. 

There is no middle ground, the disease will not 
capitulate ; either it must die or it will kill the patient. 
The doses should be gradually increased, two granules 
of each substance being given at first three times 
daily, and this quantity being increased according to 
the indications, without any fear of an accumulation, 
which is never seen, in fact, not even if doses which 
are apparently exaggerated are administered. This 
treatment may be continued indefinitely; in fact, its 
principal advantage consists in so doing. It is entirely 
useless to experiment with any form of treatment or 
alimentation, however much hope it may give us, if it 
can only be followed out during a more or less limited 
period. The advantage which may be gained from it 
is ephemeral, and is compensated inversely by the loss 
of ground which follows these attempts and leaves the 
patient in a worse state than before. This has been 
the history of all those specifics which have been 
praised immeasurably, and have gone out of fashion 
again almost as soon as they came in. The same is 
true of cod-liver oil and other indigestible or nauseat- 
ing foods which are badly tolerated. 

The treatment of the hyposthenic condition should 
be continued uninterruptedly for years, until the 
patient has entirely recovered his health. It would 



ELEMENTS OF DOSIMETRIC PRACTICE. 223 

also seem advisable to proscribe and severely condemn 
all the forms of depressing, defervescent, contrastimu- 
lant treatment, etc., which may modify some of the 
symptoms for the time, but can never be of any real 
advantage to the patient. The fever and the element 
of infection, in spite of their pathological importance, 
should be treated in a very different manner from that 
which has been advised in other diseases. Suppose 
that all the bacilli have been destroyed. Shall we have 
gained anything by this means % No, for the predispo- 
sition remains the same, and a second invasion would 
be more easily made than the first. The principal in- 
dication is to overcome pulmonary atony. This point 
having been gained, the bacilli will die, finding no 
longer a suitable soil, and new bacilli will no longer 
be able to establish their colonies. Therefore defer- 
vescents and bacillicides are to be objected to as 
harmful unless it be at the beginning of the dis- 
ease, when the local adynamia can still be easily modi- 
fied, and the paroxysms of fever are not yet continu- 
ous. We should therefore prescribe at the beginning 
of the disease two granules of aconitine and two of 
digitaline, three or four times daily, to moderate the 
fever ; as a parasiticide we should give two granules of 
the sulphide of calcium every hour, if this quantity 
does not disturb the patient' s stomach nor interfere with 
his sleep. Impairment of nutrition must be carefully 
treated with those forms of medicinal food which are 
best tolerated. The phosphates of lime and of iron, the 
phosphide of zinc, the arseniates and hypophosphites 
of lime and soda, separately or in combination, will 
satisfy this requirement. Paroxysms of intermittent 
fever should be combated with small doses of the 
hydroferrocyanate or the salicylate of quinine, three 
granules at a dose being given three or four times daily. 
Profuse sweating, which annoys and weakens so many 
patients, may be profitably treated with atropine or one 
of its salts (the sulphate or the valerianate). Two 



224 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

granules might be given when one retires, and the dose 
might be repeated when one became conscious that a 
sweat was coming on. The choice of the salts of atro- 
pine must be changed from time to time, to prevent 
habituation, or agaricine might be substituted for 
atropine, five to ten granules being given two or three 
times every night. The diarrhoea which results from 
the condition of the digestive passages may be relieved 
by the use of two granules of quassine and two of pep- 
sin with each meal. If the diarrhoea is due to intes- 
tinal ulcerations, it will be relieved with difficulty. 
Two granules of the hydrochlorates of morphine and of 
cotoine may be tried every hour, or every two hours, ac- 
cording to the resistance of the symptoms and the other 
conditions of the patient. For the haemorrhages or 
hsemoptyses, five granules of ergotine may be given 
every quarter of an hour until a haemostatic effect is 
produced. Three granules of veratrine dissolved in a 
teaspoonf ul of water, and given every ten minutes, may 
serve the same end, the dose being repeated until a 
haemostatic or a contrastimulant effect is obtained. This 
drug (veratrine) is only suitable, however, for patients 
who are still strong, for florid phthisical subjects, and 
for those who resist other means of treatment. It may 
be added that iodoform is an excellent remedy for this 
disease, if it can be tolerated. It may be given in 
doses of three granules every two hours. Its function 
is to disinfect the expired air and to quiet the cough. 
Helenine may be found useful as an expectorant, two 
to five granules being given three to fiYQ times daily. 
For the fatiguing cough, the neuralgias, and the in- 
somnia, the salts of morphine, cicutine, and cannabine 
may be given. The pains which accompany the disease 
may be treated with one granule of hyoscyamus every 
three hours, while the vomiting may be checked by 
combining the hyoscyamine with strychnine. Little 
more need be said in respect to this disease, which is 
the least satisfactory of all diseases as to its treatment 



ELEMENTS OF DOSIMETRIC PRACTICE. 



225 



— whether in practice or in theory. This feeling of 
repugnance is justified by the unhappy result which 
almost invariably occurs, though it is still the physi- 
cian's duty to struggle with it to the end, without giv- 
ing way to despair. Cases of positive cure which have 
occurred in all stages of phthisis demand perseverance 
in treatment, and justify the hope of a satisfactory re- 
sult. It is for these reasons that we should prevent, as 
far as possible, the severe consequences which almost 
always follow pulmonary inflammations of greater or 
less extent, and not limit ourselves to fighting with the 
existing disease. These morbid intercurrences should 
be met and cut short on account of the great impor- 
tance which they have in respect to the development of 
the disease. 



I Dominant. 



Variant. 



Impaired nutrition . 

Pulmonary adynamia 

f Bacillar infection 
Haemorrhages . 
Nocturnal sweating . 

Diarrhoea . 

Fever 

Cough 
Neuralgia 



j Arsenious acid. 
"I Phosphates. 

iArseniate of strychnine. 
Phosphoric acid. 
Hypophosphite of strychnine. 
j Sulphide of calcium. 
\ Iodoform. 
\ Ergotine. 
1 Veratrine. 
j Atropine. 
( Agaricine. 
( Pepsin. 
-j Agaricine. 
( Cotoine. 

( Digitaline, aconitine. 
■< Salicylate and hydroferrocyanatt 
( of quinine. 

Iodoform, morphine, helenine. 
j Tannate of cannabine. 
( Hyoscyamine, Gregory's salt. 



Dysentery. — Science has not yet found out the real 
cause of dysentery. With some individuals it is sim- 
ply an inflammatory affection ; with others it is the 
result of parasitic infection, and is due to particular 
forms of bacteria. The progress of the disease, its con- 
tagiousness, the constancy of certain accordant causes 
in all cases, tend to confirm the second theory. Dys- 
entery appears to be localized primarily in the colon, 
whence it extends to the small intestine, the liver, the 

15 



228 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

lungs, etc., gradually involving the entire organism, 
which is apparently suffering from a slow and pro- 
gressive intoxication. The dominant should, therefore, 
be chosen from the parasiticides. But, considering the 
results of treatment with the standard remedies in 
classical practice — that is, such remedies as ipecac and 
calomel — it would appear that the best means of anti- 
parasitic treatment is furnished by the organism itself 
in the shape of the bile. In fact, at the very beginning 
of the disease, as soon as the bile comes in contact with 
the surface of the colon, the disease is usually checked, 
and a cure is announced by the presence of the bile in 
the intestinal evacuations. Cholagogues should there* 
fore occupy a predominant position in the list of reme- 
dies. The excellence of the results which have been 
obtained by ipecac, as well in temperate as in tropical 
climates — the drug itself, and the method of its use in 
this disease, having been brought to us from tropical 
climates — should induce us to use it by means of its 
alkaloid emetine as the principal means of treatment. 
It must be conceded that it has a specific action, the 
exact method of which is not known, though it evidently 
operates particularly upon the liver and the nerves, 
which are distributed in the abdominal viscera. As to 
the frequency of dosage which is required, the toler- 
ance of the stomach must be consulted. If there is a 
tendency to vomit, we should administer one granule 
every two hours, and, if there is still nausea, we should 
combine with each dose two granules of codeine. If 
the stomach will allow it, we should give two granules 
of emetine every hour until there is a manifest remis- 
sion of the symptoms. The spasmodic element, which 
almost always accompanies the pathogenic element, 
requires the combination of hyoscyamine with eme- 
tine, and thus the therapeutic effect of the latter will 
be more rapidly obtained. If the emetine can not be 
borne at all, five granules of calomel may be given 
every hour. Cotoine may also be tried, but with these 



ELEMENTS OF DOSIMETRIC PRACTICE. 227 

three remedies the dominant indication can usually be 
satisfied. It must not be forgotten that the case is 
always sufficiently urgent to institute an active and 
systematic treatment, whatever be the apparent or real 
benignity of the disease at its beginning. There is no 
question but that the stages of dysentery succeed each 
other regularly, and that one comes in contact with the 
last only in those cases in which the first have not been 
treated according to proper rules. But, while the dis- 
ease is readily curable in its early periods, it is very 
rebellious in the later ones, because the means which 
are intended to overcome the morbid principle can not 
accomplish it, because the lesions have extended 
greatly, have gained in significance, have multiplied, 
and because there are secondary complications which 
have their seat in the parts which are most subject to 
vital depression, which lead to adynamia, to gangrene, 
and to death. When the disease begins we may treat 
the acholia with Sedlitz Chanteaud, but not with such 
persistence as to increase the debility of the patient. 
If there is high fever, and it is usually of a remittent 
or an intermittent type, it may be moderated by the 
use of aconitine, while the hydroferrocyanate of qui- 
nine may be used to arrest the periodic character of 
the paroxysms. The aconitine may be given in doses 
of one granule every hour or every half -hour, according 
to the temperature ; the quinine in three-granule doses 
every hour during the remissions, the use of the aconi- 
tine being resumed when the temperature again be- 
comes elevated. The vomiting, which, as has been 
observed, may compel a modification of the treatment, 
and is also the cause of the great physical prostration 
which is experienced by sufferers with dysentery, may 
be treated with codeine, Sedlitz Chanteaud having first 
been given. The codeine should be given in doses of 
two granules every quarter of an hour, and, besides 
checking the vomiting, it will also soothe the abdominal 
pain, which is sometimes almost unbearable if narcotics 



228 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

are omitted. The adynamia, which is sometimes mani- 
fested from the very beginning of the disease, may be an- 
ticipated or relieved, if it has actually occurred, by one 
or two granules of sulphate of strychnine given every 
two hours. Tenesmus, which is a great source of suffer- 
ing, and which quickly reduces the vital forces, may be 
treated with one granule of hyoscy amine every half -hour 
until relief is obtained. Should the physiological ef- 
fects of hyoscyamine or its congeners, atropine or datu- 
rine, be manifested before the therapeutic effects, its 
administration must be interrupted, but not abandoned, 
two granules of gelsemine being substituted for the 
time every half-hour. The rectal haemorrhages, which 
do not proceed from exudations, but from ulcerated 
vessels, often constitute an annoying element in the 
disease, because they increase the weakness which is 
already sufficiently pronounced from other causes. 
These haemorrhages should be treated by means of 
three granules of ergotine every hour, without sus- 
pending the other medicaments. Ataxia and delirium 
call for the use of the bromide of camphor, the sedative 
and antispasmodic properties of which will aid the 
dominant treatment. Two or three granules may be 
given every two hours or oftener, as the case demands. 
In some cases pains, which resemble those of rheu- 
matism, are present, and should be treated by the bro- 
mide of camphor, for they are almost always the result 
of spasmodic contractions ; at other times the pains 
are actually rheumatic, and therefore demand the use 
of colchicine, the cholagogue properties of which are 
thus added to the treatment of the dominant. One 
granule may be given every two hours. The suppura- 
tion in the cellular tissue which surrounds the colon 
or the rectum is a dangerous consequence of ulcera- 
tions in the mucous membrane, and should be treated 
persistently with iodoform and arseniate of soda. Two 
granules of each may be given three or four times daily. 
The paralysis of the sphincter ani and the permanent 



ELEMENTS OF DOSIMETRIC PRACTICE. 229 

prolapse of the rectum should be treated with excito- 
motor agents for a long time. The hypophosphite of 
strychnine is to be preferred, six to eight granules 
being given daily. The icterus which attends the first 
stages of the disease calls for no particular or immedi- 
ate treatment. Should it persist after the dysentery 
has been controlled, colchicine combined with the ar- 
seniate of quinine may be used, two granules of each 
being given three or four times daily. Dysentery often 
appears in such a manner that the clinician is com- 
pelled to regard it as a manifestation of malarial infec- 
tion. In such cases nothing can control it more effect- 
ually than ten granules of the salicylate of quinine 
every three hours. 

Gangrene, whether manifested in the rectum or in 
remote organs, should be treated with disinfectant rem- 
edies locally (for example, injections of a bora ted solu- 
tion of chloral, Hebert's formula for which is the fol- 
lowing : 

Chloral hydrate 10 grammes. 

Borax 5 " 

Aquse 250 " 

Sig. : Dissolve a tablespoonful to a glass of water), 
while internally two granules of salicylate of ammonia 
may be given every hour. Chronic dysentery may be 
regarded as a simple catarrhal inflammation. Treat- 
ment should be directed to the inflammation of the 
mucous membrane, and two granules of aconitine and 
two of the arseniate of soda may be given three times 
daily. If there is tenesmus, we should give as a variant 
one granule of hyoscy amine and one of emetine every 
two or three hours. The diet should be tonic but not 
stimulating, and may include rare meats, milk, and 
albuminous fluids. The patients should not be debili- 
tated by depletive means, such as leeches, etc. Dysen- 
tery may be regarded as the cholera of the large intes- 
tine ; a very slight weakening of the physical forces 
may prove an insurmountable obstacle to a cure: 



230 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



Dominant. Parasitic element . 

/ Acholia .... 

Fever .... 

Vomiting 

Pain .... 

Adynamia 
Tenesmus 
Haemorrhage . 
Ataxia .... 
Delirium 

Rheumatoid pain . 
Perityphlitis . 
Periproctitis . 
Paralysis of the sphincter 
ani .... 

Icterus .... 

Malaria .... 

Gangrene 

\ Chronic stage 



Variant. ( 



Emetine. 

Sedlitz, calomel, 
j Aconitine. 
I Hydroferrocyanate of quinine. 

j- Codeine. 

Sulphate of strychnine. 
Hyoscyamine, gelsemine. 
Ergotine. 



Bromide of camphor. 
Colchicine. 



I Iodoform, arseniate of soda. 

(• Hypophosphite of strychnine. 

Colchicine, arseniate of strych- 
nine. 

Salicylate of quinine. 
( Salicylate of ammonia. 
( Antiseptic injections. 
\ Aconitine, arseniate of soda. 
( Emetine, hyoscyamine. 



Dysmenorrhea. — Difficulty in the expulsion of 
the menstrual products may arise from various causes, 
which must be carefully studied and understood in 
order to establish a rational and efficacious plan of 
treatment. The obstacle may be either dynamic or 
organic. In the first condition there is a spasm of the 
neck of the uterus, analogous to the spasmodic contrac- 
tion of the neck of the bladder* In the second condi- 
tion there is equal difficulty in disposing of the men- 
strual fluid, but the cause is different. At one time it 
may be due to an obstruction in the cervical canal, con- 
sisting of mucus, etc. ; at another, the obstruction may 
consist of a tumor of different characters ; at another, 
in the presence of coagula or the debris of mucous 
membrane which have not been discharged. Spasmodic 
dysmenorrhcea is the form which yields most readily to 
treatment. One granule of atropine or daturine given 
every half -hour during the paroxysms of pain will allay 
them, and permit the free passage of the catamenial 
flow. In the intermenstrual periods one granule of the 
sulphate of atropine and one of the sulphate of strych- 
nine may be given three times daily. If the obstacle is 



ELEMENTS OF DOSIMETRIC PRACTICE. 



231 



due to congestion or inflammation of the mucous mem- 
brane, its engorged condition producing a stricture of 
the canal, we should use, during the intermenstrual 
period, two granules of aconitine three times daily. If 
the canals concerned in menstruation are normal in 
caliber, and the difficulty arises from the quality of the 
secretions, we should give ergotine to assist the uterus 
in expelling the body which it contains, and hyoscya- 
mine to overcome the cervical spasm, which almost al- 
ways accompanies the exaggerated irritability of the 
body of the uterus after that organ has vainly attempt- 
ed to empty its cavity. Stricture, whether cicatricial, 
congenital, or organic, should be treated by gradual 
dilatation. For endometritis, with its abnormal dis- 
charges, we should use for a long period iodoform, 
arseniate of iron, hydrotherapeutics, revulsives, etc. 
The same treatment applies for membranous dysmenor- 
rhea. Uterine colic, which is sometimes excessively 
painful, should be treated with one granule of hyos- 
cyamine every quarter of an hour, or two granules of 
tannate of cannabine every quarter of an hour. Dys- 
menorrhea, which is caused by the presence of foreign 
bodies in the uterus, by polypi, or other tumors, must 
be treated by surgical means, with reference to its cause. 
During the menstrual crisis we should help the general 
condition (indirectly) by giving strychnine, which will 
strengthen the contractile force of the body of the 
uterus, and hyoscyamine, which will facilitate the dila- 
tation of the neck. This will not cure the disease nor 
destroy its cause, but it will make the expulsive action 
of the uterus as effective as possible. 



C Spasmodic dysraenorrhoea . 
'Dominant J Congestive dysmenorrhcea . 
1 l x ' 1 Inflammatory dysmenorrhcea 
[ Atonic dysmenorrhcea 
l Stricture of the cervix 



Variant. 



Daturine. 

j- Aconitine. 

Ergotine. 

Gradual dilatation. 
( Iodoform, arseniate of 
( iron. 

j Colic Tannate of cannabine. 

[ Foreign bodies and tumors . Surgical means. 



Endometritis 



232 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Dyspepsia, — Dyspepsia is a disturbance of one or 
of several of the functional acts which contribute to 
effect normal digestion. This complex digestive func- 
tion is subject to different causes, which require a hy- 
gienic and pharmaceutical treatment, varying accord- 
ing to the case. With some, all that is required in 
the way of treatment is a slight modification in the 
way of diet, or perhaps only a greater degree of care 
in mastication ; with others, there must be the com- 
bined influence of several different means, hydrothera- 
py, electricity, nervines, eupeptics, etc., in order to 
effect a cure. The physical, chemical, and mechanical 
acts which are necessary for the transformation of food 
into absorbable material begin in the buccal cavity, are 
continued in the stomach, and are terminated in the in- 
testine ; and, as dyspepsia may be established in any 
one of these cavities, therapeutics must consider buccal, 
stomachal, and intestinal forms of dyspepsia. Buccal 
dyspepsia is caused by imperfect mastication, by loss 
of the teeth, or by a diminution in the ptyalin or dia- 
stase which is secreted by the salivary glands, and the 
object of which is to convert starchy matters into glu- 
cose. Mastication should therefore continue for a cer- 
tain length of time, especially if the teeth are absent or 
imperfect, not only that the mechanical division of the 
food may be properly accomplished, but also that the 
starchy matters may be impregnated with saliva, and 
be transformed (to a greater or less degree) into dextrine 
and then into glucose. Diastase is especially useful, 
therefore, in buccal dyspepsia, to supplement the nat- 
ural ptyalin. Having been artificially supplied to the 
stomach, it digests the starches which it finds there, 
which without this ferment would remain in the stom- 
ach like foreign bodies, unaffected by the gastric fluids. 
Three granules of it may be used with each meal in 
which starchy substances form a portion. Diastase is 
not a true medicament for conditions like this, for it 
does not produce any curative dynamic modification. 



ELEMENTS OF DOSIMETRIC PRACTICE. 233 

Its role is limited to the production of an artificial 
digestion. To increase the salivary secretion we should 
use the nitrate of pilocarpine, which excites both the 
internal and external glands of the tegument to action. 
Three granules of it should be used two hours before 
each meal. The gastric form of dyspepsia is due to 
lesions affecting contractility, secretion, or innervation. 
The muscular tunic of the stomach may be so affected 
that its peristaltic movements become very weak. The 
result of this will be that the food in the stomach is 
not sufficiently impregnated with gastric juice, and 
that chymification takes place too slowly. Then the 
stomach is gradually dilated by the gases which are 
generated in it, its atonic condition becoming more and 
more pronounced. Such is the pathogenesis of flatu- 
lent dyspepsia and of gastric dilatation in its simplest 
form. The effective agents in the treatment of this 
form of dyspepsia are those which will restore to the 
organ the energy of contractility which it lacks. Such 
are the sulphate of strychnine, of which one to three 
granules may be given before meals ; euonymine or 
elaterine, five granules at a dose ; brucine, two to three 
granules ; hydrotherapy, electricity, massage, etc. In- 
directly we may attain the same result by diminishing 
the work of the stomach by a proper selection of food, 
by reducing the quantity which is taken, and by giving 
preference to those which are fluid or semi- solid, which 
offer less resistance to the functional action of the 
stomach. It is also desirable that plenty of time should 
be allowed for the meals, and both pepsin and diastase 
administered with the meals, that digestion may be 
accomplished as rapidly as possible. The regimen 
should be adapted to the capabilities of the stomach, 
but at the same time the strength of the system at large 
must not be interfered with. Upon this theory is es- 
tablished the method of washing out the stomach with 
Fancher's tube, and artificial feeding by the same 
means, which has given excellent results in cases of 



234: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

gastric dilatation. In other cases the contractile power 
of the stomach is exaggerated, and as a result the 
patient suffers from vomiting and eructations. This 
frequently occurs during the first months of preg- 
nancy. The so-called uncontrollable vomiting will 
almost always yield to the influence of two gran- 
ules of hyoscyamine combined with one of sulphate 
of strychnine, which, by restoring the physiological 
equilibrium, will readily dissipate the spasmodic con- 
dition which is the cause of the vomiting. The stom- 
ach has two varieties of glands. In one of them is 
secreted the gastric juice, which contains the pepsin 
which is indispensable for the conversion of nitro- 
genized substances into peptone ; the others secrete 
mucus, and by their situation seem to be intended 
to facilitate the passage of the bolus of food through 
the pylorus. The quantity of pepsin which is con- 
tained in the gastric juice may be too small to effect 
a prompt peptonization of the proteids with which 
it comes in contact, which consequently remain in 
the stomach and undergo decomposition, the exist- 
ence of which is announced by the liberation of offen- 
sive gases, and by diarrhceal discharges which contain 
undigested food. For this form of dyspepsia, which 
has the name of putrid dyspepsia, two or three gran- 
ules of pepsin may be given with each meal, and two 
drops of hydrochloric acid in a glass of water after 
meals. The treatment may be completed by the use of 
peptones, of meat powder, of food in general which is 
not highly nitrogenous, of milk, and, as antiferments, 
three granules of salicylate of quinine and two of iodo- 
form. If the passage of imperfectly digested food 
through the alimentary canal causes colic, three gran- 
ules of codeine may be administered after each meal, 
or three of cocaine with each meal, the dynamophoric 
and antidyspeptic properties of this drug being very 
valuable. The vomiting is due to indigestion, and the 
principal remedy is still pepsin. If the slow effects of 



ELEMENTS OF DOSIMETRIC PRACTICE. 235 

this substance can not be waited for, sulphate of atro- 
pine may be substituted, one granule being used every 
half-hour until the proper effect is produced. Hyos- 
cyamine and atropine tend to destroy the appetite and 
to increase the lingual catarrh ; but these are transient 
effects, and, after they have disappeared, they leave 
the patient in a better condition than he was before 
the use of the mydriatic alkaloids. If the quantity 
of pepsin in the gastric juice is excessive, symptoms 
of acid dyspepsia are apparent. This excess may 
be remedied by the use of two granules of the ar- 
seniate of soda and two of the salicylate of soda 
with each meal, and alkaline mineral waters. Pyro- 
sis may be treated by the same means, and cardi- 
algia by three granules of cicutine after each meal. 
The treatment of acid dyspepsia may be completed 
by proper exercise, including stimulation of the sweat- 
glands, three granules of the carbonate of lithia three 
times daily, and abstinence from all stimulants. An 
exaggerated secretion from the mucous glands of the 
stomach causes pituitary dyspepsia. It should be 
treated with the bitters, especially quassine, in doses 
of two to live granules three times daily, and two to 
three granules of brucine. A proper dietetic regi- 
men should also be determined upon, and rigor- 
ously carried out. Condiments and alcoholic liquors 
should be avoided, and either a diet of milk or the 
grape-cure will be found to be serviceable. Disturb- 
ances in the gastric innervation will give rise to gastro- 
dynia, which is the characteristic feature of gastralgic 
dyspepsia. In its treatment, three granules of the tan- 
nate of cannabine or of the hydrobromate of morphine 
may be used, combined with one granule of hyoscya- 
mine or three of codeine, and repeated as often as the 
pain requires. Under the head of those classes of dys- 
pepsia may also be placed diminution of the appetite, 
or anorexia ; excess of the same, or boulimia ; and per- 
version, or heterophagia. Anorexia requires different 



236 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

treatment, according to its cause. Generally the appe- 
tite may be excited by the nse of two grannies of quas- 
sine or two of piperine before eating. Two or three 
grannies of veratrine, three times daily, will almost 
always have a similar effect. Bonlimia may be relieved 
by one grannie of atropine every three hours, or three 
granules of morphine every half -hour until the vora- 
cious character of the appetite is overcome. Hetero- 
phagia, which is also known as pica or malacia, requires 
a severe hygienic regimen and the use of one granule 
of hyoscyamine, combined with one of strychnine, two 
hours before eating. Such are the means for treating 
these well-defined forms of dyspepsia. Unfortunately, 
they rarely appear singly, and the symptoms which 
are associated with them result in the manifestation of 
very complex conditions. It is therefore necessary to 
combine different agents in treating them, and to select 
the most important among the phenomena for succes- 
sive treatment, in the order of their gravity and their 
affiliation. Sedlitz Chanteaud should form an essential 
portion of the treatment of almost all forms of dyspep- 
sia. It is indispensable for relieving the alimentary 
canal of portions of undigested food, which would be- 
come sources of renewed trouble if allowed to remain. 
It also acts by virtue of its alkaline properties, and 
enables one to dispense with the alkaline mineral wa- 
ters. The hygienic and alimentary regimen, regulated 
in accordance with the agencies which have brought 
about the dyspepsia, is also deserving of careful con- 
sideration. Indications of this kind occupy almost the 
entire attention of the most celebrated physicians of 
the official school. Experience taught them that Galen- 
ic preparations were harmful, not only because they 
annoyed the patient, but because of the difficulty which 
the stomach experienced in digesting insoluble and 
irritating substances. Such substances almost always 
exaggerated the disease ; or, if they did not, they were 
taken with a sense of horror by the patient, who was 



ELEMENTS OF DOSIMETRIC PRACTICE. 237 

also compelled to persevere in their use for a long time. 
Such treatment bears no resemblance to that which 
consists in the use of alkaloids. Under this system the 
granules are taken with the greatest facility, and with- 
out the slightest repugnance. They are readily dis- 
solved when they come in contact with the mucous 
membrane, and are absorbed in a few minutes without 
effort and without fatigue. The triumph of dosimetry 
in chronic diseases is never so manifest as in diseases 
of the alimentary canal. Intestinal dyspepsia might 
also be considered, but the indications which pertain 
to it are almost always those of gastric dyspepsia. 
Pepsin and diastase in combination should be pre- 
scribed for it, and the biliary secretion should be stimu- 
lated by the use of cholagogues, which have a tonic 
action upon the intestine — such as jalapine, colo- 
cynthine, elaterine, and iridine — three or four gran- 
ules being given with each meal. 

DYSPEPSIA. 

1st. Buccal. 

Mechanical troubles Prolonged medication. 

Deficiency of ptyalin .... Diastase, nitrate of pilocarpine. 

2d. Stomachal. 
Lesions of Contractility. 

Flatulent dyspepsia . \ W^ of strychnine. 
J L r ( yuassine. 

uonymine, 
electricity. 

Spasm . . -j E^tifns ! '. \ \ H y°scyamine, strychnine. 

Lesions of Secretion. 

-n;™;~ +• * • , Apepsia . . Pepsin, hydrochloric acid. 

Diminution of pepsin j ^eructations Iodoform; salicylate of quinine. 



(Flatulent dyspepsia . 1^0^^ 
Atonv •) * C^uassme. 

7 ' •(Dilatation. . . i ^"W hydrotherapy, 



Putrid dyspepsia . j™f; 

Increase of pepsin . i J rosis 

(Acid dyspepsia.) ( Cardialgia . 

Increase in the secretion of mucus . 

(Pituitary dyspepsia.) [• Quassine, brucine. 

Vomiting 



Codeine. 

Sulphate of atropine. 

Arseniate of soda, carbonate 

of lithia. 
Cicutine, cocaine. 



238 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Lesions of Innervation. 

Pain (gastralgic dyspepsia) . . ■ \Xot?Zn, ^ ^^ 

Anorexia Quassine, piperine, veratrine. 

-r, ,. . ( Atropine, hydrochlorate of 

Boulimia \ morphine. 

Heterophagia Strychnine, hyoscyamine. 

3d. Intestinal. 

Deficiency of pancreatin .... Diastase, pepsin. 

Deficiency of bile Iridine, colocynthine, eiaterine. 

Intestinal atony Jalapine, brucine. 

Emphysema, Pulmonary, — After emphysema has 
been established, whatever be its cause, it will be im- 
possible to cure it entirely. It belongs to that class of 
irreparable lesions for which treatment can only ameli- 
orate this or that symptom. But, as such lesions are 
generally progressive, we should aim at a plan of treat- 
ment which will prevent or retard development, as far 
as possible, and delay the time when the condition will 
be incompatible with life. If we can not hope that the 
alveoli, after their forcible dilatation, will recover the 
resisting power which they have lost, we can at least 
increase the resisting power of those which are still un- 
injured. Notwithstanding the incurability of the dis- 
ease, there is still a dominant indication, which is to 
fortify the resisting power of the pulmonary tissue. 
This will be accomplished by the use of the hypophos- 
phite of strychnine during the entire duration of the 
disease ; two granules should be given three to five 
times daily. The variant should endeavor to remedy 
the venous stasis, by increasing the cardiac contractility 
by the use of three granules of caffeine every two hours ; 
to this two granules of the arseniate of strychnine may 
be added every hour when the circulatory disturbances 
make the condition one of danger. Dyspnoea is the 
fatal consequence of emphysema ; suffocation may be 
temporarily relieved by the use of revulsives. Palpita- 
tions, which are the expression of cardiac troubles re- 
sulting from interference in the regular course of the 
blood-current, demand digitaline in order that the ac- 



ELEMENTS OF DOSIMETRIC PRACTICE. 239 

tion of the heart may be more regular and vigorous ; 
two granules may be given two or three times daily. 

The catarrh, which is the result of stasis and subse- 
quent paralysis, may be relieved for a time with large 
doses of ergotine ; three to five granules may be given 
every hour. The cough should be effectively treated, 
not only because it is a source of great discomfort to 
the patient, but also on account of the bad effect which 
it has upon the progress of the emphysema ; all mus- 
cular effort tending to make this condition rapidly 
worse. For this purpose the most useful agent will be 
morphine, either the hydrochlorate, the hydrobromate, 
or the hydriodate being used ; and this will not only 
greatly diminish the number of attacks of cough, but 
by its tonic action upon the cardio-pulmonary functions 
will assist the other medicaments in arresting the de- 
velopment of the emphysema. 

^ . /Dominant. Atony of the pulmonary tissue . . Strychnine. 

W^j i /Venous stasis Caffeine. 

Ph £3 \ I Dyspnoea Apomorphine. 

r| an Variant. ( Palpitations Digitaline. 

" ' Catarrh Ergotine. 

I Cough Morphine. 

Encephalitis, Acute.— Acute encephalitis is al- 
most always consecutive to inflammatory lesions of 
organs which bear more or less intimate relations with 
the brain. The most frequent of such lesions is otitis, 
especially if the otorrhceal discharge does not find a 
ready exit externally. Acute encephalitis should be 
thoroughly treated with aconitine, and with the greater 
activity as its use is begun near the starting-point of 
the disease, and as the general symptoms are the more 
acute. The congestions which are established around 
the inflammatory center, which are the cause of the 
extension of the disease, and give rise to many symp- 
toms, should be perseveringly treated, if we desire to 
prevent that aggravation of the disease which occurs 
in the majority of cases. The frequent repetition of 
these hypersemic conditions may be prevented, as far 



240 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

as is possible, by the combination of cocaine with aconi- 
tine, two granules of each being given three or fonr 
times daily. The cephalalgia, when it is simply con- 
gestive, will disappear nnder the use of two granules 
of caffeine every half -hour, but if it is associated with 
suppurative inflammation we should use codeine, nar- 
ceine, or the tannate of cannabine in two-granule doses 
every half -hour until relief is obtained. The vertigo 
may be due to a variety of causes, but is most fre- 
quently associated with disorders of the circulation and 
with intracranial pressure. This symptom will almost 
always yield to the valerianate of atropine in doses of 
one granule every two hours. Disorders of vision and 
hearing, convulsions and contractures, will be relieved, 
if they are susceptible of relief, by one granule of 
hyoscyamine every half-hour. Delirium may result 
from disorganization of the nervous tissue, or from 
irregularities in the circulation of the blood. If from 
the latter of these two causes, we should give one 
granule of digitaline and one of aconitine every two 
hours. 

Different forms of paralysis attend this condition, 
some of which are curable, while others are not. But, 
as the curable can be differentiated from the non-cura- 
ble only by the fact of their disappearance, we should 
persevere in efforts to facilitate the return of motion. 
Two or three granules of brucine may be given three 
or four times daily, to fulfill this indication. The fever, 
which is the measure of the severity of this condition, 
should always be treated with defervescents until the 
desired result is obtained. Such agents should consist 
of a combination of veratrine, aconitine, digitaline, and 
the hydrobromate of quinine, in doses which are re- 
peated with sufficient frequency to control the hyper- 
thermia. Constipation, which is very common in en- 
cephalitis, may be modified by the regular use of three 
to five granules of podophyllin every night, with Sedlitz 
Chanteaud in the morning if necessary. Retention of 



ELEMENTS OF DOSIMETRIC PRACTICE. 



241 



urine, which is almost always due to spasm of the 
vesical sphincter, may be relieved by one granule of 
daturine every two hours. In almost all cases strych- 
nine must be combined with it to overcome the spas- 
modic condition, two granules of the sulphate being 
given with each dose of daturine. Vomiting may be 
relieved by a combination of two or three granules of 
codeine with an equal quantity of quassine every half- 
hour. If these means should prove inefficient, we may 
use two granules of the hydrobromate of morphine 
every quarter of an hour. In the remissions of the 
disease, which suggest a return to health, the cerebral 
functions must not be stimulated, and irritability of 
the nervous system may be quieted by the use of two 
to four granules each of digitaline and aconitine every 
evening. Improvements of this character must not de- 
ceive us and encourage inactivity as to treatment, but 
rather should they stimulate us to interference, with 
more hope that a useful purpose will be accomplished. 



GO 



I Dominant. Inflammatory element . 
Congestion 
Cephalalgia . 
Vertigo .... 
Troubles of sight and hearing 
Contractions . 
Convulsions . 
Delirium. 
Paralyses 



\ Variant. / 



Fever 



Constipation . 
Retention of urine 
^Vomiting 



Aconitine. 

Cocaine. 

Caffeine. 

Valerianate of atropine. 

Hyoscyamine. 

Aconitine, digitaline. 

Brucine. 

Veratrine, aconitine, digi- 
taline, hydrobromate of 
quinine. 

Podophyllin. 

Daturine. 

Codeine, quassine. 



Encephalitis, Chronic (Sclerosis of the Encepli- 
alon). — When sclerosis begins to show appreciable 
symptoms, the lesions have already reached such an 
advanced stage that a cure can not be expected by any 
course of treatment. Only a decided modification of 
the nutrition of the nervous centers could effect a re- 
generation of the compromised tissues, or prevent the 
neoplastic process from continuing to develop. If 

16* 



242 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

syphilis has taken possession of the organism, we can 
accomplish much by an active course of antisyphilitic 
treatment ; but in other cases we shall do well if even 
slight results are obtained with a combination of iodo- 
form and phosphide of zinc. Four granules of each 
may be used three or four times daily. The fever and 
perisclerotic congestions may be checked by the use 
of one granule of aconitine every half-hour, in acute 
cases ; in chronic ones, by two granules, two to four 
times daily. Abolition of functions, which results 
from the destruction of organs which should execute 
or direct certain functions, is irreparable. Cephalalgia, 
which is almost always caused by congestion, will yield 
to aconitine, which is also the best remedy for periph- 
eral neuralgias in general. In some cases gelsemine 
will be more suitable than aconitine, especially if the 
case present decided evidences of depression ; two gran- 
ules may be given every half-hour. For vertigo, two 
granules of caffeine should be given every half -hour, 
or guaranine in similar doses, or valerianate of atropine 
in one-granule doses every hour. The paralyses which 
result from want of equilibrium in the innervation may 
be overcome by the prolonged use of sulphate of strych- 
nine, two granules being given every two hours. Those 
forms which result from the destruction of gray matter, 
owing to the proliferation of the neuroglia, are com- 
pletely incurable, the progress of the disease being 
marked by successive congestions, followed by inflam- 
mation with proliferation. The plan of treatment 
should be directed mainly against hyperemia, if we 
desire to prevent, or at least to retard, the progress of 
the lesions. 

°3 /r>mi/rTMATtfT J Modification in the nntri- j Iodoform, salts of mercury, 
tion of the nerve-tissue \ Phosphide of zinc. 



Fever . ) 



Congestion 
Abolition of function 
Variant. (Cephalalgia . 
Neuralgia 
Vertigo . 
i Paralysis . 



Aconitine. 

Incurable. 

Aconitine. 

Gelsemine. 

Caffeine. 

Sulphate of strychnine. 



ELEMENTS OF DOSIMETRIC PRACTICE. 213 

Endocarditis. — See Pericarditis. 

Enteritis. — Enteric fluxion may be produced by 
the most varied causes, and none of them should be 
overlooked if therapeutic intervention is to be really 
effective. Enteritis may arise from direct irritation, 
as is the case when imperfectly digested food is con- 
verted into a foreign body within the intestines, and 
inflammatory reaction of the intestinal mucous mem- 
brane is the result. Dyspepsia, therefore, is frequently 
the cause of enteritis. In such a case pepsin would be 
indicated to facilitate digestion, and Sedlitz Chanteaud 
to secure regular evacuations of the bowels. Of the 
pepsin, two or three granules may be given with each 
meal. If constipation exists, the prolonged contact of 
fecal matter with the intestine, together with the irri- 
tation which is caused by its decomposition, may result 
in inflammation. The daily use of Sedlitz Chanteaud, 
and of three to Hive granules of podophyllin at night, 
will be sufficient to relieve most of the cases. The 
presence of worms and other foreign bodies in the 
intestine has the same pathogenic action, and calls for 
the same treatment. Irritative fluxion, whether direct 
or reflex, if it is repeated and intense, almost always 
demands the use of aconitine, one or two granules 
being given three or four times daily. Reflex irrita- 
tion may be caused in different ways, the most fre- 
quent of which are associated with the action of cold, 
extensive lesions of the skin, and strong moral emo- 
tions. In the first case, it is necessary to excite to 
action the secretory functions of the skin by means of 
aconitine, which acts not only as a preventive of con- 
gestion, but also as a diaphoretic ; one granule may be 
given every half-hour or every two hours, according to 
circumstances. In the second case, since the condition 
is one of nerve paralysis rather than of vascular irrita- 
tion, the hydrochlorate of morphine is preferable, and 
two granules of it may be given every hour. The sup- 
pression or diminution of a hsemorrhoidal flux may 



244 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

also excite intestinal congestion by a compensatory 
action. If haemorrhoids are present, we may use two 
grannies of aconitine and two of ergotine three or four 
times daily ; while for dysmenorrhea, one granule of 
veratrine and one of hyoscyamine may be given every 
two hours. The stasis which is caused by hepatic or 
cardio-pulmonary lesions requires that the nervous 
system be relieved of its excess of blood. The use of 
leeches may be of service, but in general it will suffice 
to administer a heart tonic, and to produce sufficient 
purgation to diminish the intestinal congestion. To 
accomplish this purpose, two granules of digitaline 
may be given two or three times daily, and ^ve of 
podophyllin every hour, until four doses have been 
given. In other cases the enteritis is the result of gen- 
eral infection of the organism. If it is due to malaria, 
which is indicated by a more or less pronounced peri- 
odicity of the intestinal disturbances, five granules of 
the sulphate of quinine may be given every hour. If 
the cause is typhoid or variolous intoxication, the sul- 
phide of calcium, or the salicylates of soda, quinine, 
or iron, may be given in doses of two granules every 
two hours. The dyscrasias may also give rise to exces- 
sive intestinal secretion with or without diarrhoea, as 
is seen in the case of Bright' s disease, cancer, etc. The 
best agents for such conditions are cotoine, in three to 
five granule doses four to six times daily, and diuretics 
to divert the discharges into other channels. Impor- 
tant symptoms which can not be neglected are pains of 
a colicky character, which should be treated with the 
hydrobromate or the hydrochlorate of morphine, in 
two-granule doses every quarter of an hour. They 
may be used alone or in connection with one granule 
of hyoscyamine every half -hour, if there are excessive 
contractile efforts. Mucous diarrhoea should be treated 
with morphine and brucine, two granules of each being 
given every hour. Digestive troubles demand the use 
of quassine and pepsin, two or three granules of each 



ELEMENTS OF DOSIMETRIC PRACTICE, 245 

to be given with each meal. Fever should be treated 
with one granule of aconitine every quarter of an hour, 
or less frequently if the fever is not severe ; and this 
treatment should be adopted before that which is de- 
signed to check the catarrhal discharges. Icterus, 
which is frequently present when the upper portion 
of the intestine is involved, may be treated with Sed- 
litz, to which two granules of calomel every hour may 
be added. 

The foregoing are the most common symptoms in 
catarrhal enteritis. If the disease is of the choleriform 
variety, or cholera nostras, the same treatment which 
was prescribed for epidemic cholera (see under Cholera 
Morbus) should be followed, for the disease has the 
same clinical physiognomy, and differs from the epi- 
demic form only by its slight mortality rate, and the 
infrequency of the cases at a given period. The most 
frequent symptoms of this variety are vomiting and 
serous diarrhoea, which may be treated with one to 
three granules of hydrochlorate of morphine and of 
sulphate of strychnine, every quarter of an hour, dis- 
solved in a stimulant infusion. Hypothermia may be 
effectively treated with two granules of phosphoric 
acid every half-hour. Painful cramps may be relieved 
by one to three granules of the bromide of camphor 
every quarter of an hour, or one granule of hyoscya- 
mine every half -hour. Adynamia requires heavy wines, 
should the vomiting continue, together with one gran- 
ule of the sulphate or the hypophosphite of strychnine 
every hour. In the chronic form of this disease the 
symptoms are quite different. Those which require 
particular attention are constipation, tenesmus, and 
lientery. The first should be treated with two or three 
granules of veratrine three or four times daily ; the 
second, with one granule of atropine every two or three 
hours ; and the third, with a diet of milk, meat pow- 
der, peptones, etc., together with pepsin and diastase 
to assist the digestion. 



216 ELEMENTS OF THERAPEUTICS AND PRACTICE, 



ENTERITIS. 



f Direct irrita- 
tion . 

Reflex irrita- 
tion 

Compensatory 
fluxion 



Stasis 

Infection 
^Dyscrasias 

Catarrhal 



T Dyspepsia . 

•I Coprostaxis 

I Foreign bodies . 

( From cold 

•< Cutaneous lesions 

( Moral emotions 

j Haemorrhoids . 

( Dysmenorrhcea . 

I Of hepatic origin 

< Of cardio-pulmonary 

( origin . 

( Malaria 

1 Typhoid . 

( Variola 

\ Bright's disease 

( Cancer 

" Colic . 

Mucous diarrhoea 

Apepsia . 
Fever 
V Icterus 



Sedlitz Chanteaud, pepsin. 
Sedlitz Chanteaud, podophyl- 

lin. 
Podophyllin, aconitine. 
Aconitine. 

Nitrate of pilocarpine. 
Hydrochlorate of morphine. 
Aconitine. 
Veratrine. 
Podophyllin. 

r Podophyllin, digitaline. 

Sulphate of quinine. 

Sulphide of calcium. 

Salicylates. 

Cotoine. 

Diuretics, 
j Hydrobromate of morphine. 
{ Hyoscyamine. 
j Hydrochlorate of morphine. 
( Brucine. 

Quassine, pepsin. 

Aconitine. 

Sedlitz Chanteaud, calomel. 



Epilepsy. — It is not yet known with positiveness 
in what way epilepsy is originated. While it may be 
said that cerebral anaemia is the primordial lesion, this 
does not suffice to give us a clear knowledge as to its 
pathogenetic process. In cerebral anaemia, which is 
caused, for example, by lesions of the aortic orifice, we 
seldom observe disturbances like those which charac- 
terize the morbus sacer. There must therefore be 
something besides cerebral anaemia which acts as the 
cause of this neurosis. Epilepsy has been the subject 
of patient investigations, and the occasion for the most 
varied forms of treatment. At the present time, most 
of the drugs which were formerly employed have been 
discarded, the treatment being limited to large doses of 
the bromide of potassium. Medication with this drug 
furnishes results which are apparently favorable ; but, 
if the case of the patient who has undergone such treat- 
ment is followed for some time, it will be seen that im- 
provement is almost always temporary, and is likely to 
be counterbalanced by psychical lesions of an impor- 
tant character. In the author's opinion, the use of the 



ELEMENTS OF DOSIMETRIC PRACTICE. 247 

bromides in large quantities should be reserved for 
cases which are rebellious to every other form of treat- 
ment, and in which the repeated attacks of the disease, 
and the psychical troubles which are peculiar to it, 
render life unendurable. Before using the bromides, 
we should try other agents which are less harmful, and 
in many cases are quite as beneficial. We should first 
distinguish idiopathic from symptomatic epilepsy. The 
latter may or may not be curable, according as the con- 
dition of which it is a symptom is or is not curable. 
Reference is now made to the former variety in detail- 
ing a plan for treatment. Cerebral ansemia should be 
treated with atropine, the doses being regulated by the 
tolerance of the patient, and care being always taken 
not to exceed the physiological effect. Twice a day, 
one to three granules of atropine may be given, whether 
the attacks occur regularly or not. If they occur peri- 
odically, or are announced by unequivocal prodromal 
symptoms, the treatment should be of a still more act- 
ive character ; and, as the time for an attack approach- 
es, one granule should be given every half -hour, until 
the throat is dry and the pupils are dilated. The sus- 
ceptibility of the nervous centers should be controlled 
by hydrotherapy and gymnastics, so regulated that 
they will not be harmful instead of useful. Certain 
diatheses have a decided influence upon the production 
of the disease. We should therefore insist upon anti- 
diabetic treatment, if we desire to obtain certain and 
durable results. The arthritic diathesis calls for the use 
of two granules of colchicine two or three times daily, 
and two granules of the salicylates of soda and lithia 
three times daily. In cases which are associated with 
syphilis, three granules of iodoform should be given 
three times daily, or six to twelve granules of the 
iodide of mercury daily. Scrofula demands two 
granules of iodoform and two of the arseniate of 
iron three times daily ; and chlorosis three gran- 
ules of the valerianate of iron three times daily, or 



248 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

six to nine granules of the arseniate of manganese 
daily, together with two granules of the hypophos- 
phite of strychnine, three times daily. The readi- 
ness with which attacks are sometimes excited by 
causes which are apparently insignificant shows that 
there is an exaggerated condition of irritability, both 
central and peripheral. This condition may be relieved 
by the use of two to four granules of the bromide of 
camphor three times daily, and the number of doses 
may be increased if the sensibility of the patient indi- 
cates that an attack is approaching. Mobility of the 
nervous system may be relieved by two or three gran- 
ules of the valerianate or the phosphide of zinc three 
times daily. For the excitability of the medulla ob- 
longata, which is sometimes the principal cause of epi- 
lepsy, but of the nature of which we are ignorant, we 
should give for a long period one granule of aconitine 
and one of cicutine three times daily. The cardiac 
troubles, which influence the circulation deleteriously, 
and by that means the functional activity of the nerv- 
ous system, may be treated with two granules of digi- 
taline and live of caffeine two or three times daily. 
Nocturnal attacks may be controlled by giving, each 
night before retiring, five granules of croton chloral 
every quarter of an hour until a hypnotic effect is pro- 
duced. The sirup of the hydrate of chloral will produce 
the same result ; but its effect upon the digestive organs 
is bad. In rebellious cases of epilepsy we may use ni- 
trate of silver, though its efficiency is doubtful, or the 
bromide of potassium,which will control the attacks more 
or less completely as long as its sedative action lasts. 

EPILEPSY. 

g /Pathogenic Cerebral anemia . | Atropine, hydrotherapy, gymnas- 
S J /a ,+!.,**« AUM«*A. i Colchicine, salicylates of soda and 



„, , Arthritic diathesis . -j of lithia> 

5 / Syphilis . . . Iodoform, iodide of mercury. 

\ Etiologic i Scrof ulosis . . Iodoform, arseniate of iron. 

i Valerianate of iron, arseniate of 
manganese, hypophosphite of 
strychnine. 



ELEMENTS OF DOSIMETRIC PRACTICE. 249 

/Exaggerated central and peripheral ) Bromide f hoi , 

irritability ) * 

. Mobility of the nervous system . j V ^ nate and P hos P hide of 

| J Excitability of the medulla oblon- ) Aconi t ine and cicutme> 

gata ) 

Cardiac troubles .... Digitaline and caffeine. 

Nocturnal attacks. . . . j ^°^J^° Y ^ ™ ^^ ° f 

Rebellious cases . . . . | ^t^ of silver, bromide of po- 

Epistaxis. — The predisposing and determining 
causes of nasal haemorrhages are those which pertain 
to all haemorrhages. Among the most frequent of 
the former are youth, the lymphatic and sanguineous 
temperaments, degeneration of the vascular tunics, 
stimulating food, insolation, etc. Among the latter 
are traumatism, active and passive congestions of 
the cranium, sneezing, foreign bodies, etc. Under 
whatever form the haemorrhage may be produced, 
it is evident that the principal lesion consists in the 
want of resisting power on the part of the vascular 
walls. The dominant vital indication will consist, 
therefore, in increasing their tonicity by restoring the 
contractility of their muscular elements. The most 
useful medicaments in the majority of cases will be 
three granules of ergotine every quarter of an hour, or 
one granule of sulphate of strychnine every quarter of 
an hour. When the haemorrhage is caused by active 
congestion, we should meet it with aconitine, as well 
during the crisis as in the intervals, one granule being 
given every half-hour until the symptoms disappear. 
Two granules twice daily will prevent the recurrence 
of the flow, especially if digitaline be combined with it. 
Epistaxis from passive congestion should be treated 
with revulsives, derivatives, and the sulphate of strych- 
nine, combined with digitaline, to facilitate the venous 
circulation. Two granules of each may be given three 
times daily. In the cases in which the dyscrasias are 
complicated by haemorrhages, two granules of the ar- 
seniate or the phosphate of iron may be given every 



250 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

two hours during the attacks ; two granules three times 
daily in the intervals. The adynamic forms of disease 
are often accompanied by nasal haemorrhage. We 
should give, in such cases, two granules of ergotine, or 
of sulphate of strychnine and phosphoric acid, every 
hour until the desired effect is obtained. Malarial poi- 
soning may have for one series of phenomena epistaxis, 
which is more or less periodic in character. Twenty 
granules of the sulphate of quinine, with three of the 
arseniate of strychnine, three times daily, will cause the 
disappearance of this symptom, which in some cases 
may excite alarm on account of its resistance to all the 
haemostatics. The haemorrhage appears periodically 
in some cases in which malarial poisoning is not a com- 
plicating element. It is so in those cases in which it 
is excited by alcoholic liquors, by irritating food, etc. 
Aside from the removal of the cause, which does not 
always suffice, as the organism, in such cases, seems to 
have acquired a habit of congestion, it is indispensable 
that the arseniate or the hydroferrocyanate of quinine 
be given in two-granule doses three times daily. The 
anaemia which results from severe or frequently re- 
peated haemorrhages from the nose, and which pre- 
disposes the patient to additional haemorrhages, may 
be cured by the use of two granules of quassine and 
three of the salts of iron three times daily. Syncope, 
in debilitated persons, or in those with whom the loss 
of blood has been considerable, should be treated at 
once with phosphoric acid, hypophosphite of strych- 
nine, and caffeine, one granule of each being given 
every quarter of an hour. If the condition of the pa- 
tient is such that the rapid absorption of medicinal 
substances can not be anticipated, a gramme of ether 
should be injected into the cellular tissue, and this will 
quickly revive the patient. Internal treatment should 
be supplanted in such cases by the use of suitable local 
haemostatics. The most efficient means of this charac- 
ter are a three- or six-per-cent solution of perchloride 



ELEMENTS OF DOSIMETRIC PRACTICE. 251 

of iron, which may be injected into the nostrils, a ten- 
per-cent solution of cocaine, or, as a last resort, the 
plugging of the anterior and posterior nasal fossae. In 
simple cases of haemorrhage, such, for example, as may 
constitute a natural therapeutic agent, cold will suffice, 
if a haemostatic is required, applied to those regions 
which are most sensitive — for example, the testicles, 
sides, chest — or compresses saturated with ether may 
be applied to the frontal region. 



/Dominant. . Vascular atony 

' Active congestion 
Passive congestion 
Causal . . ( Dyscrasias 



tf ] /Periodicity 

^f> | f Anaemia 



Ergotine. 
Aconitine. 

Strychnine, digitaline. 
Arseniate of iron, 
ynamia . . Sulphate of strychnine. 
Malarial poisoning Sulphate of quinine. 



E" 1 \ g | | Adynamia 

^ Ipt 

Hydrof errocyanate of quinine. 



Quassine, iron. 
j Phosphoric acid, hypophos- 
\ phite of strychnine "caffeine. 

Local haemostatics. 



^Symptomatic gyncope 

1 llhinorrhagia 

Erysipelas. — Pathologists are not in accord as to 
the primary cause of erysipelas. While some consider 
it a specific disease, others recognize in it only the char- 
acters of a simple inflammation of the skin. Such is 
the influence which is exercised by preconceived no- 
tions that the simplest facts are differently interpreted 
by different authors. Jaccoud, for example, considers 
erysipelas as a cyclical disease — that is to say, a series 
of phenomena with a definite duration, the phenomena 
succeeding each other in a regular order, and disap- 
pearing in obedience to the action of remedies. Hebra, 
on the contrary, denies that there is any regular order 
in the succession of these phenomena, and that their 
duration can either be determined or foreseen. This 
variability in the phenomena is so little influenced by 
treatment that Hebra is persuaded that the result will 
always be the same, whatever form of treatment is fol- 
lowed. According to the same author, most of the 
patients recover, some of them die, but the relative 
mortality remains constant from year to year. Let us 
see if it is possible to harmonize these two opposing 



252 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

views. Dosimetry can not admit, however, that the 
same disease can be cyclical and non-cyclical at the 
same time. It has been said of dosimetry that it is a 
system of medicine which is limited to symptoms, but 
that is the case only when the poverty of science pre- 
vents it from being anything else. 

Always, on the contrary, when the fundamental 
cause is known, dosimetry procures the most active 
weapons for fighting it. That is the reason why it 
never loses from view the principle of the dominant, 
which has so important a bearing upon all questions of 
pathogenesis. From a knowledge of such questions 
therapeutic results proceed, and these should be the 
object and aim of all physicians who desire to cure or 
to relieve their patients. Every cyclical disease pre- 
supposes a morbid principle which undergoes a certain 
evolution, and, in so far as this evolution is incomplete, 
the disease has not terminated. This morbid agent is, 
then, a substance which lives in our organism. For- 
tunately, we know that these agents may die before 
they have completed their natural evolution ; further- 
more, we know what agents will destroy them, and in 
this fight we possess weapons of precision to use against 
the infinitely small, but likewise the infinitely numer- 
ous. This theory of specificity reckons among its most 
distinguished defenders Wells, Yelpeau, Bouillaud, 
Trousseau, Gosselin, Jaccoud. Even before the micro- 
scope had demonstrated the enemy, its presence was sus- 
pected, and since then the question of the existence of 
the parasite has been settled by the labors of Hueter, 
Orth, Cohn, Bouchard, and, quite recently, Dupeyrat 
and Fehleisen. The opposite theory will not yet admit 
that it is defeated, and, while it does not deny the exist- 
ence of parasites in the blood and other fluids of ery- 
sipelatous patients, it attributes their existence to 
; morbid modifications in the organic liquids, which 
' enable the parasites to live. The cultures recently 
made by Fehleisen with micrococci (bacterium jpunc- 



ELEMENTS OF DOSIMETRIC PRACTICE. 253 

turn) found in the lymphatics of that portion of the 
skin which has been invaded by erysipelas, and the re- 
production of the disease with all its characteristics in a 
woman by inoculation with these culture fluids, have dis- 
sipated the last doubts of the few remaining partisans 
of the humoral and inflammatory doctrine. But, if it is 
demonstrated that erysipelas is a parasitic or a microbi- 
otic disease, how does it happen that so careful an ob- 
server as Hebra has failed to recognize the fact that the 
disease is of a cyclical character % How can its contagi- 
ous character, its eruptive phenomena, its reproduction 
by inoculation, be harmonized with the inconstancy of 
its duration \ The solution of this question is furnished 
by the study of the disease. Its progress is essentially 
the same as that which exists, or is believed to exist, in 
connection with furuncles, which are propagated and 
multiply by a kind of auto-inoculation. Parasitic in- 
fection is therefore local, that is, limited to a certain 
zone of the skin. For, by studying the morbid process 
upon that zone exclusively, it is observed that the 
disease always evolves in the same way, and that its 
duration is constant in all cases. It is really, then, a 
cyclical disease. But, as it almost always extends and 
is propagated per contagium, as Hebra says, it happens 
that it varies in its ensemble, according to the nature 
of the tissues attacked and its extension, which gains 
from step to step. In other words, the disease is com- 
posed of a variable series of local invasions, each one 
of which is subject to the same invariable rule of mor- 
bid phenomena. The cyclical character of erysipelas 
explains the want of success which has attended its 
treatment with the means which have hitherto been 
used, Jaccoud even declares that the power of the 
physician is limited to converting into a serious form 
this disease, which is usually of a benign form. Hebra, 
after having obtained the same result from treatment 
of different kinds, concludes in favor of the expectant 
method. Louis shows by statistics, which are as exten- 



254 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

sive as they are exact, that the most active form of 
treatment can boast of shortening the disease by only 
three quarters of a day when compared with other 
methods. This result is not surprising, for, aside from 
the fact that the treatment is almost always exclusively 
symptomatic and most frequently local, allopathic 
means of medication are almost always perturbing, and 
very rarely effective. The treatment should be both 
fundamental and symptomatic ; in other words, both 
the dominant and the variant should be enforced. 
Since erysipelas is due to the proliferation of the 
bacterium punctum, we should oppose this morbid 
agent during the entire course of the disease by the 
most efficient parasiticides. As a rule, the alkaloids 
are parasiticides, which accounts for the results ob- 
tained in eruptive fevers by the administration of def er- 
vescents — aconitine, veratrine, digitaline, and strych- 
nine. The most efficient agent in all diseases of this 
kind is sulphide of calcium, and its use should not 
be neglected as soon as the disease appears. Its 
action may be increased, if necessary, by the use of 
salicylic acid and the salicylate of quinine. The 
sooner one has recourse to the dominant, the greater 
will be the profit which is derived from it. It is 
all important to establish the diagnosis as soon as 
possible, and thus prevent the extension of the disease 
by the dissemination of its germs. During an epidemic 
the diagnosis is easily made in consequence of the 
painful engorgement of the glands in the vicinity of 
the region in which the exanthema is first apparent. 
Sulphide of calcium should be given every quarter of 
an hour or every hour, or in two-granule doses every 
two hours, according as one designs to accomplish the 
checking or the attenuation of the disease. The period 
of invasion is sometimes announced by such violent 
chills that they seem like the precursors of pneumonia. 
In this stage of febrile movement we should give phos- 
phoric acid and the sulphate or the arseniate of strych- 






ELEMENTS OF DOSIMETRIC PRACTICE. 255 

nine. The valerianate or the arseniate of caffeine will 
relieve cephalalgia. Nausea and vomiting, which in- 
dicate that the parasite has established itself upon 
the gastro-intestinal mucous membrane, require evacu- 
ants, of which Sedlitz Chanteaud, emetic, or emetine 
will be found efficient. For children emetine should 
be preferred, two or three granules being dissolved 
in a little water, and the dose being repeated at inter- 
vals of ten minutes until vomiting is produced. In 
the period of eruption, when by the sensitiveness of 
the organism the foreign bodies which irritate it are 
expelled from the tissues, all the phenomena are still 
due to the presence of the parasite. The dominant is 
always indicated therefore, and the variant must be 
chosen in accordance with other indications which, 
though secondary, should engage our attention. The 
fever, which is almost always elevated, might, perhaps, 
be of service, if we had not always other weapons for 
the essential cause of the disease ; but, as there are other 
means at our disposal, we should modify the fever so as 
to economize the forces of the body to the greatest pos- 
sible extent. The means which may be used to over- 
come the disease by assisting the dominant, when the 
febrile elevation interferes with its action, are veratrine, 
when the digestive passages are obstructed or the 
phlogosis of the skin is excessive ; digitaline, when 
there is delirium in consequence of an irregular distri- 
bution of the blood ; aconitine, when the fever exceeds 
39°; the arseniate or the salicylate of quinine, when the 
type of the fever is intermittent or remittent. Delirium 
from cerebral anaemia, when the fever is very high, will 
yield to the use of generous wine and arseniate of strych- 
nine ; albuminuria, which is almost always transient, 
calls for means which will facilitate diuresis without un- 
duly stimulating the renal function. Such means may 
be supplied with a few granules of colchicine or of digi- 
taline. After the parasites have been destroyed, means 
should be employed to excite elimination of the morbid 



256 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



products which they have left behind them, and, as 
bacteria prefer the protective tissue, it is in these 
tissues especially that elimination should be stimu- 
lated. Diaphoretics, and among them the nitrate of 
pilocarpine, may be used with advantage ; but as a rule 
the action of the sulphide of calcium upon the skin 
will be sufficient both to kill and to eliminate the para- 
site. When the digestive organs are in such a condi- 
tion that reparation by means of food is too slow, the 
appetite may be revived and the strength increased by 
quassine, arseniate of iron, and sulphate of strychnine. 
Local or external means of treatment should be limited 
to the use of weak local disinfectants ; for example, of 
lycopodium, salicylated starch, or camphor. External 
applications of cotton wool will also be of service in 
preventing contact with the atmosphere and dispersion 
of the germs. Constant applications of cold water will 
also soothe the patient and reduce the local as well as 
the general temperature ; they will in addition assist 
in destroying the microbes. Though such applications 
may sometimes be useless, they are at least, according 
to Hebra, always free from danger. The means which 
have been devised for preventing the entrance of the 
microbes into the body may sometimes be injurious. 
In the attempt to derive much benefit from such means, 
we might unintentionally destroy the lymphatic vessels, 
by which the elements of the disease are disseminated. 



( Dominant. . -f Inf action by the baote 



( 1st period : 
Invasion, 



2d period : 
Eruption. 



3d period : 
\ Destruction. 



num punctura 
Chills . 

Cephalalgia . 

Nausea and vomiting 
'Fever . 

Delirium 

Albuminuria 
; Gastric disturbance 
Elimination of morbid 

products 
Restoration of strength 



and relief of gastric •< Arseniate of 



atony 



( Salicylate of quinine. 
I Sulphide of calcium. 
] Phosphoric acid, sulphate 
( of strychnine. 

Valerianate or arseniate 
of caffeine. 

Emetine, emetic. 

Veratrine, digitaline. 

Arseniate of strychnine, 
wine. 

Colchicine. 

Sedlitz Chanteaud. 

Sedlitz Chanteaud. 

Nitrate of pilocarpine. 
( Quassine. 



( Sulphate of strychnine. 



ELEMENTS OF DOSIMETRIC PRACTICE. 257 

Fever, Intermittent. — See Paludal Infection (un- 
der Infection). 

Fever, Puerperal. — Under this title will be con- 
sidered the infectious and contagious parasitic disease 
which occurs during the puerperal condition, and is 
known under the different names of puerperal metritis, 
puerperal metro-peritonitis, puerperal typhus, puerpe- 
ral poisoning. The characteristic feature of this dis- 
ease is an infectious element, which has not yet been 
thoroughly investigated, which is believed by many to 
be a ferment, and which bears the name of lochine. 
The inflammatory element, which is often regarded as 
the most important one, is often present as a predispo- 
sition to or a complication of the disease, but of itself 
it is not sufficient to produce the condition which is 
known in practice under the name of puerperal fever ; 
on the contrary, we sometimes see the infectious ele- 
ment appear by itself, without any evidence of inflam- 
mation on the part of the uterus. In a word, there is 
a puerperal metro-peritonitis of an infectious charac- 
ter, but there may also be puerperal infection without 
metro-peritonitis. It is the predisposition to puerperal 
infection caused by metritis, and the frequency with 
which inflammatory lesions are produced by the lochial 
virus, which has influenced many writers to believe in 
the identity of the two conditions. But, if the differ- 
ences of opinion of the pathologists in respect to the 
pathogenesis of this disease are to be regretted, their 
agreement in respect to prognosis is equally so. In 
fact, as Pajot says, "if they differ in regard to its 
pathogeny, they agree in regard to its fatal character," 
which demonstrates the absolute impotence of the 
official method of practice, and the uselessness of all 
forms of treatment which have been recommended by 
the different schools. Pajot has even added: "The 
only treatment for puerperal fever consists, on the part 
of women, in not having it, and, on the part of physi- 
cians, in not communicating it." Still one sees popular 
17 



25S ELEMENTS OF THERAPEUTICS AND PRACTICE. 

physicians prescribing remedies in which they have 
faith every day, but the inefficiency of which is sadly 
demonstrated by results, at least to those who are not 
blinded by routine action. The sulphate of quinine is 
the remedy which is always prescribed for puerperal 
fever. The patients die one after another, but the tra- 
ditional treatment continues, notwithstanding these 
consequences. Why should we change, for magister 
dixit f Official science has yet to find any other reason 
for its practice in this matter. Since death is certain, 
whether large doses of quinine are or are not given, 
why should the quinine be insisted upon ? If some 
other agent were employed, however unlikely success 
from its use might seem, there would at least have been 
the merit of attempting to save one' s patients ; but to 
continue in the use of a drug which constantly gives 
negative results is not justifiable. The one who con- 
demns quinine as useless, and with high authority, is 
Pajot himself, the specialist in diseases of this charac- 
ter. Ten years ago he wrote: "I gave sulphate of 
quinine in large doses so often during the lifetime of 
the lamented Dr. Beau that no illusion concerning this 
drug could be experienced by me. Marvelous as is its 
action in other conditions, it is perfectly useless in the 
one which we are discussing." (Letter to Dr. Yerrier, 
in the " Gazette Obstetricale," concerning the treat- 
ment of puerperal fever.) The dosimetric system is 
more fortunate. Its plan of medication varies in ac- 
cordance with the symptomatic phenomena, but its 
object is always to attack the cause of the disease by 
interpreting in a logical manner its true nature. It 
does not always succeed, perhaps because the infection 
is already so pronounced that it quickly annihilates 
the vital forces, in the absence of which there can be 
no curative action ; perhaps because its intervention is 
required when the anatomo-pathological lesions can 
not be relieved — a condition which is soon reached in 
puerperal fever. Notwithstanding all adverse condi- 



ELEMENTS OF DOSIMETRIC PRACTICE. 259 

tions, cures by this method are not infrequent, and 
desperate cases are recorded in its journals which are 
readily cured by alkaloid o therapy. It will be proper 
to describe the method for the prevention of puerperal 
accidents, which is useful at all times, but is indispen- 
sable during epidemics. Accouchement signifies a trau- 
matism of considerable moment, together with general 
prostration, which is the result of muscular action and 
moral impression which the patient can not avoid. The 
wounded surface is supplied with important veins, 
which, having been torn, are exposed to the contact of 
air and the decomposing liquids which form the lochia. 
It is therefore easy to understand the condition which 
may be present in the venous system from the intro- 
duction of air and the absorption of septic products, 
which include miasms, bacteria, parasites — in a word, 
agents which result in puerperal infection, and which 
are developed with marvelous rapidity. The indication 
in such cases is therefore to contract the traumatic sur- 
face to its narrowest limits, rapidly inducing uterine 
involution by means of ergotine ; to restore by strych- 
nine to the muscular and nervous systems the force 
which was expended during labor ; and to relieve the 
uterine mucous membrane of congestion, so as to avoid 
inflammation, by means of aconitine and the hydro- 
ferrocyanate of quinine. Ergotine should be given in 
two-granule doses every hour as soon as possible after 
labor is finished, and continued until the uterus has 
resumed its normal volume. After this involution has 
been obtained, we should give one granule of aconitine, 
one of strychnine, and two of quinine every three or 
four hours, until the fever which attends the establish- 
ment of lactation has disappeared. With regard to 
the curative treatment of puerperal infection, it should 
be observed that hyperthermia is the most notable 
characteristic of the disease. The fever may rise to 42° 
C, or higher, appearing in exacerbations, which occur 
once or twice daily. We have seen that the antiperi- 



260 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

odic action of quinine can not be trusted for this con- 
dition, whatever be its dosage. Something besides 
periodicity must be opposed in this fever, namely, the 
infectious element ; and this must be met with the sali- 
cylates or the sulphide of calcium, and local antiseptic 
applications. Hyperthermia demands very active def- 
ervescent treatment. The dominant may be satisfied, 
therefore, with two granules of the salicylate of quinine 
and one of aconitine every half -hour. This treatment 
is generally instituted by the author in his practice at 
the beginning of the disease, and the results have al- 
ways been very favorable, if the attendant realizes the 
importance of regularity in the administration of the 
medicine. After the disease has passed its first phase, 
we may add to the treatment two granules of the sul- 
phide of calcium every quarter of an hour, and dimin- 
ish or double the quantity of aconitine according to 
the requirements. The thermometer should be the sole 
guide for the continuance, diminution, or increase of 
the dosage. The local treatment must not be neglect- 
ed, and uterine or vaginal injections must be system- 
atically made with a 2|-per-cent solution of salicylic 
acid. Uterine injections of chloride- of -zinc solution, 
1:1,000, may also be serviceable. When the invasion 
of the disease is announced by chills, we should give 
one granule of phosphoric acid and one of the arseni- 
ate of strychnine every half-hour until a reaction oc- 
curs. It is also worthy of notice that the better the 
innervation of the system during the period of con- 
centration of the virulent influences, the better will 
be the condition of the organism to endure reac- 
tion. Abdominal pain is sometimes intense, espe- 
cially if the peritonseum is implicated ; it should be 
treated with the hydrochlorate of morphine. Two 
granules may be given every half-hour, and it will both 
relieve the vomiting and check the diarrhoea, which 
may be accompanying conditions. Insomnia, which is 
often rebellious and of grave import, may be treated by 



ELEMENTS OF DOSIMETRIC PRACTICE. 261 

similar means. The delirium and cephalalgia may re- 
quire caffeine in two-granule doses every half-hour, in 
addition to the aconitine, which will relieve them if it 
produces its complete effect. If abscesses are formed, 
indicating purulent absorption, there will be little hope 
of saving the patient. Nevertheless, it will still be 
worth while to try the effect of salicylate of ammonia, 
with iodoform and arseniate of quinine ; one granule of 
each may be given every half -hour. Prostration, which 
is almost always considerable, even when the disease 
has not been of long duration, should be treated with 
one granule of the sulphate of strychnine every hour. 
Suppression of the lochia calls for veratrine and aconi- 
tine, and retention of the urine for one granule of digi- 
taline and one of hyoscyamine every two hours. This 
plan of treatment may be followed with all confidence, 
persistence and regularity by night and by day being 
essential, and also regulation of the dosage both as to 
quantity and frequency, according to the urgency of 
the indications and the effects which are produced. 
Extreme cleanliness, ample ventilation, a tonic regimen 
regulated by the digestive ability of the patient, and 
absolute exclusion of all moral influences of a de- 
pressing character are the hygienic precautions which 
should be prescribed and rigorously observed. Cases 
of simple metritis and metro-peritonitis should be treat- 
ed as if they were infectious, for the reason that it is 
not easy to distinguish their true character at the be- 
ginning, and because it is in this first stage that they 
may be checked, and that our means of action will 
have the greatest effect. 

PUERPERAL FEVER. 
Preventive Treatment. 

Slow involution Ergotine. 

Fatigue Strychnine. 

Hyperemia j Aconitine, hydroferrocyanate of 

^ ° ' * ( quinine. 



262 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



Curative Treatment. 
(Hyperthermia . . . Aconitine. 



Dominant. / Febrile intermittence 
' \ Infectious element . 
I Local infection 

/Chills 

Abdominal pain 
Insomnia . 
Vomiting 
Diarrhoea . 



Variant. 



Purulent infection . 

Adynamia 

Suppression of the lochia 
Retention of urine . 



Salicylate of quinine. 

Antiseptic injections. 
j Phosphoric acid, arseniate of 
\ strychnine. 

I Hydrochlorate of morphine, co- 
j deine. 

j Salicylate of ammonia, iodoform, 
\ arseniate of quinine. 
] Sulphate of strychnine, generous 
\ wine. 

Veratrine. 

Digitaline, hyoscyamine. 



Fever, Traumatic, and Other Accidents ac- 
companying Traumatisms. — No one, at the present 
time, is able to tell exactly what traumatic fever is ; 
after operations and injuries a train of local and general 
symptoms is observed, with varying degrees of severity, 
from simple epitraumatic fever to purulent infection 
and septicaemia, of the nature of which we are ignorant, 
and the varieties of which are not well defined. These 
accidents do not depend essentially upon traumatism — 
that is, traumatism alone is not sufficient to produce 
them, for we often see traumatisms follow the custom- 
ary course to complete cicatrization, without any evi- 
dence that the general condition is affected. The influ- 
ence of curative agents and of the hygienic conditions 
of the wound upon the appearance and progress of dis- 
turbances of the general condition shows also that fever 
is not provoked by simple lesions of structure. The 
most reasonable theory is that fever is produced by 
the absorption of decomposed matter in the form of 
certain ptomaines, which are developed at the sur- 
face of injured tissues, and which, by modifying the 
condition of the blood, influence the innervation of 
the nutritive system to such an extent as to deter- 
mine febrile reaction. According to the malignity 
and the quantity of these products, as well as the 
facility with which they are absorbed — in a word, 



ELEMENTS OF DOSIMETRIC PRACTICE. 263 

according to the dose of these deleterious matters 
which is introduced into the blood, and the impres- 
sionability of the patient — will result the intensity of 
the traumatic fever and the development of its vari- 
ous forms. The indication is, therefore, to prevent the 
decomposition of the liquids which bathe the wound 
by perfect cleanliness, the application of unirritating 
disinfectants, and prevention of the entrance of mi- 
crobes from without ; in the second place, by relieving 
the nervous and circulatory systems of congestion, so 
as to prevent reaction from the irritation which has 
been caused by the absorption of toxic matter. This 
will be accomplished with aconitine and veratrine joined 
with tonics, such as strychnine and the hydroferrocya- 
nate of quinine. Treatment may be preventive or cura- 
tive. If preventive, it should begin, if possible, a few 
days before the reception of the traumatism, and con- 
sist in the administration of two granules of aconitine 
and two of veratrine three times daily. After the op- 
eration has been performed, we may give two granules 
of the arseniate of strychnine and two of the arseniate 
or the hydroferrocyanate of quinine three times daily 
to stimulate the nervous system, repair the losses 
which have been sustained, and develop impressions 
which should be strengthened by the modifications 
which are effected in the secretions. This treatment 
has given surprising results whenever it has been em- 
ployed. The traumatic fever becomes a matter of no 
consequence, and cicatrization takes place with remark- 
able rapidity. The absence of fever enables us to feed 
the patient liberally, a condition which is very impor- 
tant for the attainment of good results from operations. 
If this preventive treatment can not be adopted, or 
proves ineffective, we must endeavor to check energetic- 
ally the fever which is developed. We should make use 
of the same means as in the previous condition, but 
they should be used with greater activity. One granule 
of aconitine and one of veratrine may be given every 



26i ELEMENTS OF THERAPEUTICS AND PRACTICE. 

half -hour until the mercury indicates 38° C. As soon as 
there is a remission, three granules of the hydroferrocy- 
anate of quinine with one of the arseniate of strychnine 
may be given every two hours. Purulent infection calls 
for the same treatment, defervescents being added — for 
example, one granule of the salicylate and one of the 
arseniate of quinine being given every half-hour. 

In cases of septicaemia the salicylate of ammonia 
may be added, the antiseptic action of which has often 
been demonstrated by the author. Two granules may 
be given every hour. The vitality of wounds will be 
modified by dosimetric agents as surely as by external 
means — the inflammatory condition by one granule of 
aconitine every two hours ; the atony by two granules 
of phosphoric acid four times daily, and strychnine in 
similar doses ; the pain by two granules of morphine or 
gelsemine every quarter of an hour until relief is ob- 
tained. Somnolence after wounds have been received 
will indicate the use of two granules of the arseniate 
of caffeine every two hours ; want of appetite should 
be met by properly selected diet, and by two or three 
granules of quassine before eating ; constipation, which 
is of such common occurrence on account of the en- 
forced rest in bed, will be relieved by the daily use of 
Sedlitz Chanteaud. 

Suppuration of a non-laudable character, which in- 
dicates retarded cicatrization and is an attendant of 
weak constitutions and lymphatic temperaments, re- 
quires two granules of iodoform and two of the arseni- 
ate of iron three to six times daily. 

Aconitine, veratrine, arseniate 
of strychnine, hydroferro- 
cyanate of quinine. 

Quassine. 

Sedlitz Chanteaud. 

Aconitine. 

j- Iodoform, arseniate of iron. 

Arseniate of caffeine. 
Arseniate and salicylate of 

quinine. 
Salicylate of ammonia. 



« 






H /Dominant 


> 


g ) / Want of appetite . 


o< 


Constipation 


t— I w 




Local inflammation 


H 




Local atony . 


^h \ Variant. ( Slow cicatrization 




Somnolence . 


< 


Purulent infection 


H 




^Septicaemia . 



ELEMENTS OF DOSIMETRIC PRACTICE. 265 

Fever, Typhoid.— Science, in spite of its extensive 
investigations and profound discussions, has not yet 
been able to determine the causal element of this dis- 
ease, the treatment of which is about to be referred to. 
It would appear that the pathogenic element resides in 
a living agent, which originates either in man or ex- 
ternal to him, and is developed and proliferated within 
his intestines, poisoning the organism until, as a result, 
there is one of the severest diseases with which human- 
ity is afflicted. 

The effects of this intoxication are especially mani- 
fested by exaggerated bodily heat, and by rapid and 
profound diminution of the strength. If, therefore, we 
seek to eliminate the morbific agents with the material 
which serves as soil in which they may develop, to 
neutralize those which we can not eliminate, to lower 
the hyperthermia, and to prevent or effectually over- 
come the adynamia, the disease will be reduced to its 
simplest expression. Its duration will, of necessity, 
be abbreviated, and by suppressing the morbid ele- 
ments which give to it its gravity, we transform it into 
a benign disease, with a mortality which is much less 
frightful. The dominant indications naturally follow 
from these simple pathological considerations. The 
intoxication from typhoid fever does not take place in 
the same manner as in the eruptive fevers. On the 
other hand, the poisoning appears to be gradual and 
progressive, and to result from an increasing absorp- 
tion of toxic principles, rather than from a rapid infec- 
tion of the entire organism with microbes. As a thera- 
peutic corollary, it follows that an active intervention, 
in order to be effective, should begin with the first days 
of the infection ; also, that the diagnosis is difficult in 
the first stage of the disease, which is characterized by 
oscillations of the temperature, with an upward ten- 
dency. By late interference the opportunity for being 
truly useful is lost; on the other hand, the disease 
may be checked by early interference, and then the 



266 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

doubt may arise whether the condition would really 
have developed into typhoid fever. The prodromic 
signs and the course of the disease during the first few 
days are sufficiently characteristic to put the physician 
upon his guard, and compel him to act at the proper 
moment in as resolute and energetic a manner as if the 
disease were entirely established. The principal indi- 
cations to be satisfied are the following : 

1. To relieve the digestive organs of all fermentable 
materials. The Sedlitz Chanteaud, by its mild and 
moderate purgative action, by its slightly bitter taste 
which is gradually tolerated without any difficulty, 
and by its defervescent properties, is the agent which 
should be preferred. A small teaspoonful in water 
in the morning, or a large spoonful dissolved in water 
and taken during the day, will be sufficient for ordi- 
nary doses, but the quantity must be regulated by the 
intensity of the symptomatic diarrhoea of the disease. 

2. To neutralize morbific agents. This indication, 
which is fundamental, will be satisfied by the use of 
antiseptics and parasiticides. The selection of the 
means is a very important matter, for those agents 
should never be chosen which depress the vital forces 
too much, or which irritate the gastro-intestinal canal, 
the vitality of which has been so profoundly affected. 
Phenic acid, salicylic acid in large doses, the prepara- 
tions of cinchona, etc., in spite of their advantages, 
have this decided disadvantage. In addition to the 
alkaloids, which are all parasiticides to a greater or 
less degree, we should give the. sulphide of calcium, in 
two-granule doses, every two hours ; or, the salicylate of 
quinine, in one- to three-granule doses, every two hours. 

3. To moderate the hyperthermia. This necessity, 
which is universally recognized, and is observed in all 
forms of treatment, arises not only from the fact that 
prolonged hyperthermia is an element of danger, but 
also from the fact that reduction of the fever has a very 
favorable influence upon adynamia and all the conse- 



ELEMENTS OF DOSIMETRIC PRACTICE. 267 

quences of the morbid process. The method of seeking 
to obtain this result, by the use of large doses of qui- 
nine> is not the best one, for it implies considerable 
disturbance to the organism, and its use must be inter- 
rupted in order to avoid inconveniences which are per- 
fectly apparent. Defervescence should be obtained 
gradually, and therefore only such doses as are abso- 
lutely required should be given, lest the adynamia be 
thereby increased ; on the other hand, the dose should 
not be less than is required, otherwise the medication 
will be ineffective. The adaptation of the doses to the 
resisting power of the disease, that is to say, dosimetry, 
could not be improved upon in these cases. The plan 
should be fractional and repeated doses, simple and 
pure remedies, the introduction into the stomach of 
those things only which are necessary, and in doses 
which will not interfere with the absorptive capacity ; 
and this plan can not be violated without injury to the 
patient. In many cases it will be proper to dissolve 
the granules in water, or in water mingled with wine 
or milk, because the irritability of the intestinal tube 
is such that the granules will quickly pass through it 
undissolved, not finding sufficient fluid to dissolve 
them. We should also remember that the entire quan- 
tity of medicine which is taken into the stomach, even 
if in solution, is not effective — a portion of it is dis- 
charged ; and hence we can not use doses which, under 
other conditions, might be tonic, but in this disease 
will barely produce the desired effect. The deferves- 
cent agents which are used in dosimetry, and the supe- 
riority of which has been demonstrated by experience, 
are aconitine, veratrine, digitaline, hydroferrocyanate 
of quinine, or salicylate of quinine. The quinine is 
used on account of its antiperiodic effects, the others 
because of their influence upon hyperthermia. They 
should be given in combination, as in that way their 
effect will be found to be more prompt and more cer- 
tain, and, besides, given in this way their absorption 



268 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

is more probable tlian if any equivalent dose of a single 
substance is given. The frequency of the doses must 
be regulated by the intensity of the fever, and, above 
all, by the results which are obtained. When begin- 
ning the use of defervescents, we should administer 
them every quarter of an hour until the thermometer 
indicates a remission. During the first few days th& 
treatment is intended to be abortive, and, if the case is 
taken in season and the treatment is faithfully carried 
out, it will be followed by the most gratifying results. 
After this first period has passed, it will no longer be 
possible to abort the disease, and our efforts must be 
expended in the prevention of excessive temperatures. 
Then it will suffice to give defervescents every hour, 
with longer intervals at night, when remission would 
naturally occur. This plan of defervescent treatment 
may require continuance for several days ; but it must 
be kept up until its effect is produced, unless there is 
a con tra-indi cation of greater weight. In the author's 
experience it has been tried for eight days in succes- 
sion, and, when hope was beginning to fail, the change 
came rapidly. This result could have been attained in 
no other way than by obstinate persistence. Variety 
and versatility in the plan of treatment almost always 
are a source of sorrow. An illustration may be given 
in the following case : The fever was well defined, had 
reached its second stage, and presented grave symp- 
toms. The dosimetric plan of defervescent treatment 
dissipated the symptoms referable to the nervous sys- 
tem, the tongue became clean, the urine clear, and the 
temperature was reduced, but beyond this no improve- 
ment could be obtained, the defervescence remaining 
incomplete. In spite of persistent treatment, the con- 
dition could not be changed. It was not a dangerous 
one, but it was quite unusual that it should resist so 
long, though the cause, probably, was that the treat- 
ment had been begun too late. Upon the ground that 
the resistance of the fever might be due to insufficiency 



ELEMENTS OF DOSIMETRIC PRACTICE. 269 

of the medication, the old-fashioned (non-dosimetric) 
means of treatment were tried. The sulphate of qui- 
nine and the decoction of quinquina were given in allo- 
pathic doses. One day of this treatment, which is 
justly called incendiary, was sufficient to change the 
condition and bring the patient back again to the first 
condition of the disease. The tongue became dry, the 
fever increased, delirium returned ; in a word, the 
gravity of the case became such that it was decided to 
return to the dosimetric treatment, and to be more 
patient in the future. From the foregoing it will ap- 
pear that typhoid fever must not be considered as a 
disease which can be overcome in a few days. We 
must be satisfied with a simplification of the cases, a 
removal of the severe symptoms, and must leave the 
rest to the natural evolution of the disease, because 
lesions which have already been established must un- 
dergo certain absolutely essential conditions of repair. 
Jugulation of the disease is possible in its first stage ; 
after that has passed we can only hope to lessen the 
severity of it. In the majority of cases it may be said 
that typhoid fever, treated according to dosimetric prin- 
ciples, is to the same disease, treated by other methods, 
as discrete variola is to the confluent form. It is the 
same disease, and is subject to the same phases, but 
with great difference as to the suffering, the gravity, 
and the mortality which attend it. 

4. To oppose adynamia. This indication may be 
satisfied by avoiding violent remedies, and giving the 
patient a diet which is suitable to his digestive ability, 
by moderating the cause of weakness, and giving neu- 
rosthenic remedies in liberal doses, especially the 
arseniate of strychnine, of which one granule may be 
given every hour. Strychnine is the tonic par excel- 
lence, and its superiority is of that kind which builds 
up without producing irritation ; however long it may 
be used, the tissues will not become congested, and no 
lesion will be evident, even from toxic doses. It is a 



270 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

truly dynamic medicament, and might be considered 
almost a specific for typhoid fever. The secondary 
indications are more numerous than the primary, and 
among them are some which are rarely met, because 
if the treatment has been well carried out they do not 
appear. The books on pathology should give special 
attention to the association of the symptoms, and 
should separate clearly those which are essential from 
those which appear only as the result of our therapeu- 
tic inefficiency. Unfortunately, the pathologists men- 
tion in their books all the symptoms which are possi- 
ble, all consequences which are imaginable, not even 
excepting death, in connection with diseases which are 
susceptible of cure. Chapters which are terminated 
with directions respecting treatment should never con- 
found the natural evolution of a disease with its course 
when modified by the intervention of art. The epis- 
taxis, which may appear either at the beginning or in 
the course of the disease, should not be ignored ; in 
the first case, it will be a source of weakness to the 
patient, in the second it will denote, in addition, a 
grave dyscrasia. Ergotine is the proper remedy on 
both occasions ; but, in the second, it should be asso- 
ciated with the arseniate of iron or the arseniate of 
strychnine. Two or three granules of the ergotine may 
be given every quarter of an hour until the effect is 
obtained. Cephalalgia may usually be relieved with 
aconitine. Should its intensity be such that it resists 
the anticongestive power of that alkaloid, the bromide 
of camphor may be given in addition, in three-granule 
doses, every quarter of an hour. The same may be 
said with respect to the treatment of delirium which 
was said concerning cephalalgia. In addition, half a 
granule of hyoscyamine every hour will have a very 
soothing effect upon the cerebral functions. The treat- 
ment for hyperthermia has already been alluded to. In 
some cases, cold or lukewarm baths at regular intervals 
will be proper to reduce the heat. Ablutions with cold 



ELEMENTS OF DOSIMETRIC PRACTICE. 271 

water and with vinegar are also very useful, not only 
to diminish the heat, but also to preserve the functions 
of the skin in the best possible condition. If hygienic 
regulations concerning the skin are appropriate in a 
state of health, how much more during disease ! Pul- 
monary lesions in this disease are so frequent that they 
may serve as a means of diagnosis. Digitaline and 
strychnine, which have already been mentioned as 
filling important indications, have also their particular 
application in the disorders of the respiratory appara- 
tus. Should the local pulmonary lesions become severe, 
or resist the use of defervescents, bryonine may be 
associated with them, which has the property of in- 
ducing resolution of broncho-pulmonary inflammations 
without aggravating the morbid condition in the intes- 
tine ; one granule may be given every two hours. 
Vaso-motor paralysis, which is the result of the nu- 
merous and severe conditions prevailing with this dis- 
ease, may be treated with two granules of ergotine and 
two of strychnine every two hours. The active princi- 
ples of ergot, aside from their power over this form of 
paralysis, have a remarkable influence upon the course 
of the fever. For meteorism, one granule of the hypo- 
phosphite of strychnine should be given every two 
hours, together with occasional enemata of cold water. 
If the cardiac complications are of an ataxic character, 
they may be regulated by digitaline ; if they are only 
atonic, caffeine or its salts may be given in two-granule 
doses every hour. Intestinal haemorrhages indicate 
ergotine, and ice both internally and externally. Ene- 
mata of ergotine are also useful ; each one may be com- 
posed of ten grammes of ergotine and twenty of water. 
The diarrhoea, if it is held in control, is serviceable ; if 
it is excessive, it results in great weakness. Morphine 
must be used with great caution, as it readily excites 
congestion of the nervous centers; codeine or cotoine 
should be used in preference, two granules being taken 
every hour. The renal complications call for great 



272 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

prudence in the treatment, and the frequent use of the 
thermometer. They are almost always caused by the 
passage of infectious elements through the urinary 
filtering apparatus, and will only disappear when the 
pathogenic cause of the disease is overcome. The in- 
dication for the elimination of these elements or their 
residue may be met by digitaline or Sedlitz Chanteaud. 
In addition to these drugs we may give, during the 
declining period of the disease, two granules of benzoic 
acid or of benzoate of soda four times daily. Eschars 
[upon the skin — Trans.] are rarely seen in patients 
with this disease, because the adynamia and the dura- 
tion of the disease do not often lead to such a degree of 
disorganization. In cases in which they have occurred 
they may be dressed with absorbent cotton dipped in a 
one-per-cent solution of hydrate of chloral. Convales- 
cence is often marked by very severe accidents. The 
digestion may be improved by the use of two granules 
of pepsin and two of quassine with each meal. The 
arseniate of iron and the hypophosphites of lime and 
soda should also serve as elements in the reconstructive 
treatment, two to four granules of each being given 
three times daily. Should suppuration occur, we should 
administer two granules of iodoform with two of the 
arseniate of strychnine four times daily ; and, should 
the process become an extensive one, we should add 
three granules of the sulphide of calcium three or four 
times daily. For paralysis we should use two granules 
of phosphoric acid three times daily, or two to four 
granules of the phosphide' of zinc three times daily. 
The mental perturbations may result from material 
lesions or from such as are purely dynamic. In the 
first case we should give two granules of iodoform and 
two of the arseniate of soda four times daily, to mod- 
ify the nutrition ; in the second case the vaso-motor 
troubles should be met with one granule of the hypo- 
phosphite of strychnine and one of hyoscyamine, three 
or four times daily, and three granules of ergotine three 






ELEMENTS OF DOSIMETRIC PRACTICE. 



or four times daily. The foregoing enumeration of the 
possible indications is very incomplete, but the object 
has been to call attention only to those which are most 
frequent. The others, which are rare under any form 
of treatment, become still more so if an abortive plan 
of treatment is adopted at the beginning. 



Infectious element 



j Sulphide of calcium, salicy- 
( late of quinine. 

Sedlitz Chanteaud. 

Arseniate of strychnine. 

Aconitine, digitaline, vera- 
trine, hydroferrocyanate of 
quinine. 

Ergotine. 

Bromide of camphor. 

Hyoscyamine. 
j Defervescents, warm baths, 
{ cold ablutions. 

Bryonine. 

Ergotine. 
j Hypophosphite of strychnine, 
( cold enema ta. 

Caffeine, digitaline. 

Ergotine, ice. 

Codeine, cotoine. 

Benzoic acid, benzoate of 
soda. 

Hydrate of chloral (topical). 
( Quassine, pepsin, arseniate of 

iron. 
I Hypophosphites of lime and 
[ soda. 

{Iodoform, arseniate of strych- 
nine. 
Sulphide of calcium. 
Phosphoric acid, phosphide 

of zinc. 
Iodoform, arseniate of soda, 
strychnine, hyoscyamine, 
ergotine. 



Fever, Yellow. — Yellow fever is a disease which is 
evidently infectious, and a parasitic agent has been 
sought as its cause. Some investigators profess to have 
found the microbe which answers such a requirement 
in rice. The analogies of this disease with bilious re- 
mittent fever lead one to suppose that the dominant of 
the treatment is found in the salicylate of quinine, on 
account of the antiparasitic and antiperiodic properties 
of that salt. During the entire duration of the disease, 

18 





f Dominant. ( 


Adynamia 






Fever .... 


> 




''Epistaxis. 
Cephalalgia 
Delirium . . 


q( 




Hyperthermia . 


o 
W 
p-i 




Pulmonary complications 
Vaso-motor paralysis 






Meteorism 




I 


Cardiac complications 
Enterorrhagia . 
Diarrhoea .... 


Variant. < 


Renal complications 




Eschars .... 




Convalescence . 




Suppuration . 




Paralysis .... 






^Mental perturbations 



274 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



therefore, until the period of declension, two grannies 
of it should be given every half -hour. 

Its intense rhachialgia calls for two granules of the 
hydrobromate of cicutine every half-hour. The fever 
must be treated with one granule of aconitine and one 
of veratrine every half-hour until it has been sufficient- 
ly reduced. Should nausea and vomiting interfere 
with the regularity of the defervescent treatment, two 
granules of codeine should be added every half -hour, 
or one of hyoscyamine every hour. One granule of 
strychnine may also be given every hour to increase 
the tolerance of the remedies and to prevent adynamia. 

If the adynamia is severe, we must give one granule 
of phosphoric acid every two hours. 

For the haemorrhages, which announce themselves 
by the black vomit, we should use two granules of er- 
gotine or two of salicylate of iron every half-hour. 
Should melsena occur, the same treatment is indicated ; 
but the prognosis becomes very grave. 

Insomnia and delirium call for the use of two gran- 
ules of the bromide of camphor every quarter of an hour. 
Should there be suppression of urine from renal fault, 
two granules of scillitine may be given every hour ; if 
the anuria results from paralysis of the bladder, the 
catheter must be used, and strychnine resorted to. To 
diminish thirst and excite hepatico-intestinal action, Sed- 
litz Chanteaud dissolved in a large quantity of water may 
be used for an ordinary drink. During convalescence, 
two to four granules of quassine and a like quantity of 
the arseniate of quinine may be given three times daily. 



Dominant. Infectious element 
/Cephalalgia . 
Rhachialgia . 

Fever . 

Variant. \ Nausea and vomiting 

Haemorrhage 
Insomnia 
Delirium 
Anuria . 
^Adynamia . 



Salicylate of quinine. 

Citrate of caffeine. 

Hydrobromate of cicutine. 
j Aconitine, veratrine, hydrofer- 
( rocyanate of quinine. 
] Sulphate of strychnine, hyos- 
| cyamine. 

Ergotine, salicylate of iron. 

Bromide of camphor. 

Scillitine. 

Arseniate of strychnine. 

Phosphoric acid. 



ELEMENTS OF DOSIMETRIC PRACTICE. 275 

Gangrene of the Lungs. — Necrosis of the pul- 
monary tissue can be cured only by elimination of gan- 
grenous portions, and cicatrization of the cavity which 
results from such elimination. The dead tissues can 
not be restored, and therefore therapeutics has no field 
for action in respect to the principal lesion. As necrosis 
is due, however, to feeble vitality of the tissues, and as 
the tissues which are still uninvolved share in this 
feebleness to a greater or less extent, we should use all 
diligence to increase the general vitality and the resist- 
ance of the tissues in the vicinity of the gangrenous 
portion. It is only in this way that we can aid Nature 
effectively in her efforts at elimination and regenera- 
tion. Adynamia, therefore, should be treated with the 
hypophosphite of strychnine, combined with the salicy- 
late of ammonia, two granules of each being given every 
hour. The prostration which the patients experience 
should be treated with phosphoric acid, an agent which 
has great dynamophoric power, two granules being 
given every two hours. For the thoracic pains we 
should give two granules of the hydriodate of morphine 
every half -hour, or one of cicutine at similar intervals 
until relief is experienced. The fetid condition of the 
breath and of the expectoration will be overcome by 
the continued use of iodoform or of sulphide of calcium, 
one granule being given every half- hour. As to the 
cough, expectoration may be facilitated by the use of 
benzoate of ammonia or of bromide of camphor, three 
granules being given every two hours. Haemorrhage 
is always a matter of grave importance, not only on 
account of the persistence by which it is sometimes 
characterized, but also because it intensifies the prostra- 
tion and adynamia. We should attempt to check it 
with three granules of ergotine every quarter of an 
hour, combined with one granule of the sulphate of 
strychnine every quarter of an hour. The fever, which 
is often very high, tends greatly to increase the ady- 
namia. It should be treated with one granule of aconi- 



276 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



tine every hour until the hyperthermia is reduced. 
After this end has been attained, two to four granules 
of the salicylate of quinine may be given every hour. 
Diarrhoea, which is the result of the adynamia and the 
elimination of the septic products, calls for three to five 
granules of the salicylate of iron, and an equal quantity 
of the subnitrate of bismuth, three or four times daily. 
During the period of repair, we may aid the process by 
which new tissue is formed by giving two granules of 
the arseniate of iron and two of iodoform five times 
daily. The diet should be liberal and nourishing, and 
a sufficient quantity of generous wine or of cognac 
should be supplied. 



OH 



; /Dominant. 



Variant. 



Adynamia . 

I Prostration 
Thoracic pain 
Fetid breath 

Cough 

Haemorrhage 
Fever 

Diarrhoea . 

Cicatrization 



j Hypophosphite of strychnine, salicy- 
( late of ammonia. 

Phosphoric acid. 

Hydrochlorate of morphine. 

Iodoform, sulphide of calcium, 
j Benzoate of ammonia, bromide of 
\ camphor. 

Ergotine, sulphate of strychnine. 

Aconitine, salicylate of quinine. 
j Salicylate of iron, subnitrate of 
( bismuth. 

Iodoform, arseniate of iron. 



Gastralgia. — Gastralgia, cardialgia, gastrodynia, 
etc., as it is variously called, is a form of neuralgia 
which is produced as a result of the want of equi- 
librium in the innervation of the stomach, and which 
radiates, to a greater or less extent, along the distribu- 
tion of the vagus and the cceliac plexus. This idea of 
a want of equilibrium between the nerve-forces is one 
which has prevailed during every epoch of the history 
of medicine, and has served as the basis of the striatum 
and laxum theory of Themison. In fact, the constant 
observation of the processes of nature reveals and im- 
poses such a notion. In all perturbations which are 
purely dynamic, an increase or diminution of the influ- 
ence of the nerves is always observable, and its phe- 
nomena have been carefully investigated by contem- 
porary workers, such terms as inhibition and dyna- 



ELEMENTS OF DOSIMETRIC PRACTICE. 277 

mogeny, vaso-constrictor and vaso-dilator nerves, etc., 
being used to signify the elements which are involved 
and the processes in which they participate. To this 
physiological dichotomy there is a corresponding thera- 
peutic dichotomy ; to the striatum there is a counter- 
part in hyoscyamine ; to the laxum in strychnine. The 
functional lesions may, as a rule, be effectively opposed 
by one of these two agents, or by both at once, because 
it rarely happens that a compensatory spasm does not 
correspond to atony, just as to congestion there is al- 
ways a correspondent relative anaemia of the organs 
near which the hypersemia occurs, and from which the 
excess of blood has been borrowed. Gastralgia is due 
to exaggerated irritability, whether from the applica- 
tion of stimulants to the gastric mucous membrane or 
from a want of equilibrium. In other words, it is de- 
termined by the diminution of the general tone, such 
as follows, for example, the influence of depressing 
moral conditions, essential anaemia, chlorosis, etc. The 
dominant should, therefore, take cognizance of this 
pathogenic process, and hence the antispasmodic action 
of hyoscyamine will not always suffice to rapidly over- 
come the cramps in the stomach ; its combination with 
strychnine is often indispensable to restore the physio- 
logical equilibrium of the forces. When the gastralgia 
is caused by the irritating action of food or drugs, we 
should begin to soothe the contractility of the stomach 
by the use of one granule of hyoscyamine every quar- 
ter of an hour, or by means of its congeners, the sul- 
phate or valerianate of atropine or daturine, having 
first cleansed the gastro-intestinal canal by means of 
Sedlitz Chanteaud. 

If, on the other hand, the gastralgia is due to influ- 
ences of a depressing character, we should add, from 
the beginning, one granule of strychnine every half- 
hour, or of brucine if the patient is of a very impres- 
sionable disposition. As the neuralgia is due not only 
to perturbations of contractility, however, it is often 



278 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

indispensable to consider perturbations of sensibility, 
using for that reason the hydrobromate or the hydro- 
chlorate of morphine. 

The pain which results from the excessive sensibil- 
ity is sometimes so severe as to cause lipothymia of an 
alarming character. In such cases two granules of 
morphine, with two of caffeine, used every ten minutes, 
will quickly produce relief. 

Vomiting, which is sometimes of service by en- 
abling the stomach to relieve itself of the exciting cause 
of the trouble, but which almost always increases the 
nervous troubles, may be treated with three gran- 
ules of morphine and three of atropine every half- 
hour. 

Dyspepsia, which is now the cause and again the 
effect of gastrodynia, calls for two granules of the ar- 
seniate of soda with each meal. If dyspepsia exists, gas- 
tralgia may recur frequently, but with attacks which 
become less and less severe. In such cases two or three 
granules of the cyanide of zinc may be used before each 
meal. Arthritis, and particularly that form which is 
known as biliary lithiasis, is often present with gas- 
tralgic attacks. Aside from the use of soothing reme- 
dies, we should employ in the intervals two granules 
of the carbonate or the benzoate of lithia with each 
meal. 

Gastralgia may also be present as a manifestation 
of hysteria, or as an accident of chronic myelitis. In 
the first case three granules of the bromide of camphor 
three times daily will be the proper remedy ; in the 
second, two or three granules of cicutine three times 
daily. A stubborn form of gastralgia is also a frequent 
complication of anaemia, and it is the more significant 
as it interferes with regularity in the ingestion of 
food. 

Iron is indicated in such cases on account of its in- 
fluence upon the blood, and is well tolerated if the gas- 
tralgia is due to no other cause. One or two granules 



ELEMENTS OF DOSIMETRIC PRACTICE. 



279 



of the valerianate, and a like quantity of the arseniate 
of iron, may be given in such cases three times daily. 
If the gastrodynia is very troublesome, two granules of 
codeine may be given with each dose of the iron, or 
two granules of the arseniate of manganese may be 
given with each meal. Certain forms of gastralgia recur 
periodically, without reference to the time when food 
is taken into the stomach. 

For such cases three granules of the hydrobromate 
of quinine may be given every two hours, or one gran- 
ule of arsenious acid four times daily. It is superflu- 
ous to add that the cause of gastric neuralgia must be 
sought with the greatest care in order to decide upon 
the appropriate treatment. The essential conditions 
for the insurance of a cure will consist in the use of 
food which is easily digested, abstinence from tea, cof- 
fee, tobacco, and alcohol, and the suitable employment 
of hydrotherapy. 



< /Dominant. J Want of e( l uilibrmm in the 



Variant. 



I nervous sj 
/Lipothymia 
Vomiting 
Dyspepsia 
Arthritis 
Hysteria 
Myelitis 
Chlorosis 
\ Periodicity 



stem 



i Hyoscyamine. 
} Strychnine. 

Caffeine, morphine. 

Atropine, morphine. 

Arseniate of soda. 

Carbonate of lithia. 

Bromide of camphor. 

Revulsives, cicutine. 

Valerianate of iron. 

Hydrobromate of quinine. 



Gastritis, Acute. — Acute catarrhal gastritis is rela- 
tively a rare condition. It should not be compared 
with toxic gastritis, and its treatment should be varied 
with the cause which produces it. 

Phlegmonous gastritis can only be treated symptom- 
atically, and medical intervention is not of very great 
value. In acute gastritis the inflammatory element 
predominates. It should be treated with one granule 
of aconitine every half -hour, and, after the fever has 
subsided, with one granule of veratrine every quarter 
of an hour. The treatment should be begun with a 
purgative dose of Sedlitz Chanteaud, which may be 



280 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

made more agreeable to the taste by the addition of 
sugar and lemon-peel. 

If the fever is characterized by remissions, a granule 
of the hydroferrocyanate of quinine may be given 
with the defervescents every half -hour. The stomach 
sometimes rejects these medicaments, and compels an 
interruption of the treatment before any result has been 
obtained. In such cases the gastric irritability may be 
quieted by the use of two granules of codeine every 
quarter of an hour. The same agent will relieve the 
pain by which gastritis is characterized, unless it is 
intense, in which case a granule of the hydro chlorate 
of morphine must be given every half-hour. The sa- 
burral condition, which often remains after deferves- 
cence has occurred, calls for one granule of quassine 
every two hours. 

Constipation must be treated with Sedlitz ; diarrhoea 
with two granules of brucine and two of codeine every 
two hours. 

When the fever is high, delirium is sometimes de- 
veloped ; the treatment should then be eight granules 
of the bromide of camphor with sufficient aconitine 
every two hours. The cephalalgia which accompanies 
the fever will usually yield to aconitine ; but, should 
it continue after the fever has disappeared, two gran- 
ules of the citrate of caffeine may be given every half- 
hour. 

In some cases the patients will get well much more 
quickly if an emetic is given at the beginning of the 
disease. Such cases are not usually pure forms of gas- 
tritis, but are rather subacute catarrhal conditions 
which are converted into febrile forms of gastritis. In 
such cases, therefore, we may give three granules of 
emetine, dissolved in warm water, every ten minutes 
until the desired effect is obtained. 

In the more acute cases an emetic is rarely indi- 
cated. We should be guided in this matter by the 
condition of the tongue : if it is covered with a thick 



ELEMENTS OF DOSIMETRIC PRACTICE. 



231 



coating of a whitish or yellowish color, emetine is indi- 
cated ; but if it is red at the borders and more or less 
dry at the center, vomiting may do much harm. Rather 
than excite vomiting in the latter class of cases, we 
should give aconitine and Sedlitz Chanteaud and ex- 
pect the best results. 



23 /Dominant. 



Variant. 



Inflammatory element 
' Hyperthermia 

Remittent fever 

Cephalalgia . 

Vomiting 

Pain . 

Saburral condition 

Diarrhoea 

Constipation 
\ Delirium 



Aconitine, veratrine. 
Aconitine. 

Hyclroferrocyanate of quinine. 
Caffeine. 

!• Codeine. 



Sedlitz Chanteaud, quassine. 

Codeine. 

Sedlitz Chanteaud. 

Bromide of camphor. 



Gastritis, Catarrhal.— This affection (erribarras 
gastrique) is a mild inflammatory condition of the gas- 
tric mucous membrane. It generally runs an apyretic 
course, and in itself is without gravity ; but it may be 
transformed into an intense gastritis, into gastroenteri- 
tis, or typhoid fever. It is one of those diseases which 
are held up by physicians who believe in the expectant 
method of treatment as an illustration of the useless- 
ness of medical interference. 

The frequency with which this disease is incom- 
pletely cured, or its cure is retarded, and the aggra- 
vated state which it sometimes assumes from the most 
insignificant causes, teaches us that it should never be 
neglected, but should be attacked as vigorously as if it 
were a severe disease from the beginning. 

The saburral condition of the digestive organs is an 
indication for a saline laxative — for example, Sedlitz or 
citrate of magnesia — in order to relieve the intestinal 
canal of the alimentary detritus and the mucus which 
it may contain. Subsequently, as soon as possible, one 
or two granules of veratrine should be given every half- 
hour or every hour, according to the degree of toler- 
ance. Usually the tongue becomes clean within twenty- 
four hours from the time that treatment is begun, the 



282 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

appetite returns, and a cure is evident. Yeratrine has 
a particular action upon the gastric mucous membrane, 
producing a substitutive irritation and exciting the 
secretion of the gastric juice, which had been sus- 
pended. 

If the appetite continues unimproved, however, and 
the stomach still performs its functions badly, the gas- 
tric atony being a hindrance to prompt and easy diges- 
tion, two granules of quassine should be given four 
times daily. The frontal or supraorbital cephalalgia, 
and the vertigo which are not of infrequent occurrence 
in these cases, will disappear after the administration 
of a few doses of the valerianate or the citrate of caffe- 
ine, two granules being given every half-hour. Vomit- 
ing, whether of spontaneous origin or provoked by the 
inappropriate use of veratrine, which will prevent us 
from continuing the use of that remedy until its de- 
sired effect can be obtained, may be treated with two 
granules of codeine and one of strychnine combined 
with the veratrine. 

Imperfectly digested food or the irritant action of 
the gastric mucus will cause intestinal or hepatic hyper- 
secretion, which will be manifested by a more or less 
abundant diarrhoea. This condition may be readily 
controlled by the suitable use of Sedlitz Chanteaud, 
with two granules of pepsin at each meal. Only such 
food as can be easily digested should be given while 
the secretion from the gastric glands is deficient — such 
foods, for example, as milk and soups, one or two gran- 
ules of pepsin with each meal being given to supply 
the natural deficiency. The general debility which 
often follows this disease, however rapid its cure may 
have been, requires the incitant action of one or two 
granules of arseniate of strychnine three times daily. 
In some cases the use of food will excite a mild condi- 
tion of fever ; for such cases, three to five granules of 
the salicylate or the hydroferrocyanate of quinine 
should be given three times daily. 



ELEMENTS OF DOSIMETRIC PRACTICE, 283 



" Dominant. 


Inflammatory element 


. Veratrine. 


/Anorexia . 


. Quassine. 


Vomiting . 


. Codeine. 


J Cephalalgia 


. Caffeine. 


Variant. ( Saburral condition 


. Sedlitz. 




Diarrhoea . 


. Pepsin. 




General debility. 


. Strychnine. 




\ Febrile attacks . 


. Salicylate of quinine 






Gastritis, Chronic. — Chronic catarrh of the stom- 
ach results chiefly from two sources — atony of its con- 
tractile elements, and deficient secretion of the glands 
which furnish gastric juice. Difficulty in digestion, 
which arises from the combined action of these two 
morbid factors, aggravates the existing irritation and 
exaggerates the secreting power of the gastric glands 
which furnish mucus. The dominant will consist, 
therefore, in increasing contractility by means of bru- 
cine and strychnine, in facilitating digestion by the 
administration of pepsin, and in relieving the stomach 
of undigested food and unnecessary mucus by the ad- 
ministration of Sedlitz Chanteaud or emetine. To in- 
crease tonicity, hygienic means are not less efficient 
than treatment by means of drugs. Not only should 
the stomach be relieved of excessive labor, but its ordi- 
nary function should be assisted, if possible, in order 
that such an economy of work may be transformed into 
a capitalization of force. The sense of weight in the 
region of the stomach, which patients with this disease 
experience after eating, almost always comes from the 
feeble contractile power of a dilated stomach. This 
disagreeable condition may be relieved by the very 
moderate use of food and drink, and the administration 
of three to five granules of euonymine or elaterine with 
each meal. The pain which accompanies intestinal di- 
gestion may be relieved by the use of three granules of 
codeine or cocaine every half -hour. Palpitations and 
yawning are reflex phenomena which result from the 
pressure of gas which has been generated in the stom- 
ach. Two or three granules of strychnine, three times 
daily, will furnish the best means for relieving them, as 



284 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

the resistance of the muscular coat of the stomach will 
thereby be increased and distention prevented. The 
effect of this treatment will also be to ward off hypo- 
chondria, from which patients with this disease so fre- 
quently suffer. Acid eructations are the result of fer- 
mentation in the stomach. For their relief, two or 
three granules of the arseniate or the salicylate of soda 
may be given, three times daily, or the alkaline mineral 
waters may be used. Vomiting of the food should be 
treated with three granules of pepsin with each meal. 
It is almost always due to deficiency of the gastric se- 
cretion. Vomiting which is due to an excess of mucus 
in the stomach may be treated with two to five granules 
of quassine, an hour before each meal. The same drug 
will improve the appetite in cases in which there is re- 
pugnance to food ; but, if the loss of appetite is due 
entirely to disrelish for food on account of buccal ca- 
tarrh, two granules of veratrine, half an hour before 
each meal, will give prompt results, and will also over- 
come constipation, which may coexist. The cephalic 
congestion which accompanies the work of digestion, 
and which is the cause of headache, vertigo, etc., re- 
quires two granules of aconitine before each meal, and 
two of caffeine or guaranine every half-hour until the 
desired effect is obtained. Flatulence of intestinal ori- 
gin is due to inertia of the muscular fibers which enter 
into the structure of the intestine. The excito-motor 
agents, which have a tonic action upon the intestine, 
are indicated for this paresis. Two granules of strych- 
nine may be given three times daily, or three of jalapine 
or of colocynthine with the same frequency. The diar- 
rhoea should be treated with three granules of brucine 
or of narceine every two hours. Constipation requires 
different remedies, according to the exciting cause. 
Usually it may be corrected by using two to four gran- 
ules of podophyllin or veratrine every evening, and a 
small spoonful of Sedlitz Chanteaud in the morning. 
Hypochondria, which has a decided tendency to pro- 



ELEMENTS OF DOSIMETRIC PRACTICE. 



285 



duce disrelish for the food, and to make the digestion 
sluggish, should be treated by moral stimulation, exer- 
cise, and two or three granules of hyoscyamine daily. 
Chronic gastritis, in the absence of irremediable lesions, 
can always be cared by a proper choice of remedies, 
and by perseverance in their use, and in a hygienic 
regimen for a sufficiently long period. 

Strychnine. 
j§^ I Dominant. 



P5^ 

OH 

IB 



u 



Variant. ( 



Atony 

Insufficiency as to the se 

cretion of pepsin . 
Excess as to the secretion 

of mucus 
^Feeling of heaviness 
Pain. 

Palpitations 
Yawning . 

Eructations 

Cephalic congestion 

Vomiting . 
Anorexia . 
Intestinal flatulence 
Diarrhoea . 
Constipation . 
Hypochondria . 



[• Pepsin. 

I Sedlitz Chanteaud. 

Euonymine, elaterine. 
Codeine, cocaine. 

Sulphate of strychnine. 

Salicylate and arseniate of 
soda. 

Aconitine, guaranine, caf- 
feine. 

Pepsin, quassine. 

Quassine, veratrine. 

Sulphate of strychnine. 

Brucine, narceine. 

Podophyllin. 

Hyoscyamine. 

Glossitis. — Inflammation of the tongue may be 
superficial or deep. If it is superficial, it is not a con- 
dition of any particular gravity, and may be relieved 
by the use of a few granules of aconitine, which will 
act upon the inflammatory condition. The case is not 
the same if the inflammation is extensive, for then sup- 
puration frequently follows, and the patient may die 
of asphyxia. In such cases prompt interference is re- 
quired, for the progress of the disease is rapid. Medi- 
caments must be given in solution, and as frequently 
as the severity of the case demands. The fever, which 
is sometimes very high, may be relieved by the use of 
one granule of aconitine every quarter of an hour until 
defervescence results. A concentrated solution of co- 
caine (1 : 15) should be used locally to relieve pain, and 
also to produce ischsemia in the tongue. Ptyalism 
may be relieved by the use of one granule of atropine 
every two hours. Suppurative glossitis calls for the 



286 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

use of iodoform and arseniate of quinine, two granules 
of each being required every two hours. Should the 
volume of the tongue be greatly increased, it will not 
only prevent deglutition, but it will also interfere with 
respiration, and this condition will be aggravated by 
the compression which is exercised upon the vessels by 
inflammation of the cervical glands, which may occur 
simultaneously. If asphyxia is imminent, the swollen 
tongue should be relieved as rapidly as possible, either 
by deep scarifications, or by the application of leeches 
to the organ itself or to the retro- and submaxil- 
lary regions. In extreme cases tracheotomy should 
be performed as the last resort to prevent fatal as- 
phyxia. 



w5 


' Dominant. 


Inflammatory element 


. Aconitine. 


H a 




/Fever 


. Aconitine. 


CO 




1 Pain 


. Cocaine. 


o 


k Variant. 


( Ptyalism 


. Atropine. 




Suppuration . 
1 Asphyxia 


. Iodoform, arseniate of quinine. 


O 




. Leeches, incisions, tracheotomy. 



Goitre, Exophthalmic (Basedow's Disease). — The 
primordial lesion in exophthalmic goitre is in the 
sympathetic system. In consequence of this, the de- 
pendent cardiac and cervical vaso-motor action is par- 
alyzed, and dilatation of the arteries which are con- 
trolled by these nerves follows. The means which 
should be used in the treatment of this paralysis are 
ergotine and sulphate of quinine in large and long-con- 
tinued doses. The two agents may be associated, but 
it is better to use them alternately from week to week, 
giving, for example, three granules of strychnine three 
to iiYe times daily for two or three weeks, and then five 
granules of ergotine three to five times daily for an 
equally long period. 

Should the tonics to the vascular system be in- 
effective, the palpitations may be relieved by the use 
of two granules of digitaline three or four times daily, 
until relief is obtained. The vascular ectasis may be 
benefited by the use of three granules of cocaine three 



ELEMENTS OF DOSIMETRIC PRACTICE. 287 

to five times daily, its astringent action re-enforcing 
that of the dominant. The exophthalmia, which de- 
pends upon the same fundamental cause, and is a 
source of great annoyance to the patient by reason of 
the lesions which produce insufficiency of the eyelids, 
demands the use of morphine combined with the domi- 
nant, and two granules should be administered every 
quarter of an hour. If by the use of this agent the 
cephalic troubles are increased, it should be replaced 
by the sulphate of calabarine, three granules of which 
may be given three or four times daily. Conjunctivitis, 
which will appear sooner or later as a result of exoph- 
thalmia, should be treated with aconitine three or four- 
times daily. Dyspnoea will be diminished by the use 
of one granule of cicutine or of valerianate of atropine 
every half -hour. Insomnia should be treated with two 
granules of the bromide of camphor, or of Gregory's 
salt, every quarter of an hour, until a hypnotic effect 
is obtained. The delirium, which may be more or less 
accentuated, is caused by hyperemia of the cranium, 
consecutive to cerebral excitation. One granule of 
hyoscyamine given every hour will almost always re- 
store rest in the two hemispheres. Vomiting, which 
may be due to changes in the sympathetic, or is a 
symptom of cerebral disorder, requires the use of one 
granule of atropine every quarter of an hour, combined 
with three granules of quassine. The haemorrhages, 
which are very frequent in the last stage of this dis- 
ease, being the necessary consequence of the vascular 
atony and the prolonged ectasis, should be treated with 
subcutaneous injections of ergotine, the following for- 
mula being suggested, viz. : 

Ergotine (Catillon's) 1 gramme. 

Distilled water 12 grammes. 

Glycerin 3 " 

If the granules are preferred, three may be given 
every quarter of an hour. The ansemia, which is some- 
times the cause and sometimes the effect of the disease, 



238 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



should be treated with, two or three granules of the 
arseniate of iron, three times daily. Hygienic meas- 
ures, based upon the pathogenic idea of the disease, 
will consist in rest for the body and the mind, without 
entirely excluding attention to the affairs of life, in a 
moderate amount of exercise, and, in the early stages 
of the disease, in hydrotherapy. Stimulants should be 
avoided, as their use is always followed by depressing 
effects ; this remark applies to tea, coffee, alcohol, 
tobacco, and strong condiments. The diminution of 
the work of the digestive apparatus has an important 
bearing upon the restoration of the functional force of 
the sympathetic. The diet should be nourishing in 
character and abundant in quantity, but the food 
should always be readily digestible. 



BO 

o 

X 



Dominant. Paralysis of vaso-motor nerves 
/ Palpitations 
Vascular ectasis 
Exophthalmia 
Conjunctivitis 

Variant. ( py s P noe . a • 
v Insomnia . 

Delirium 

Vomiting . 

Haemorrhage 

Anaemia 



Ergotine, strychnine. 

Digitaline. 

Cocaine. 

Morphine, strychnine. 

Aconitine. 

Cicutine. 

Bromide of camphor. 

Hyoscyamine. 

Atropine, quassine. 

Ergotine. 

Arseniate of iron. 



Gout. — This specter to the rich and scourge to the 
sensual is tending to disappear in proportion as equal- 
ity is being attained by the subdivision of capital and 
labor. We are yet far from the ideal of the socialists, 
however, and for that reason the disease still prevails 
with a certain class of people who require more work 
of their stomach than of their hands. The etiology 
and pathology of gout may be sketched in a few words, 
in accordance with the observation of the past and 
the present. Diminution of exercise and excess in the 
use of food results in an incomplete combustion of 
azotized matter, which accumulates in the blood and 
determines an excessive development of uric acid, 
which is the efficient cause of the disease. This is not 
the only cause for the accumulation of uric acid, how- 



ELEMENTS OF DOSIMETRIC PRACTICE. 289 

ever, for its production may be normal in quantity, 
and uricsemia be established, owing to deficient elimi- 
nation on account of renal lesions. The system being 
saturated with uric acid and with nitrogen, and the 
usual emiinctories being no longer capable of eliminat- 
ing them, the work is forced upon other organs, which 
are unused to the task, and in which the patient expe- 
riences more or less violent pain, inflammation, etc. 
There is, therefore, for gout, an efficacious preventive 
treatment, purely hygienic in character, and consisting, 
as to its details, in abundance of exercise and spare 
diet, especially with reference to nitrogenous food. 
This plan of treatment would be equally curative if 
habits of intemperance were not so difficult to over- 
come. If we could inspire the patient with the passion 
of avarice, or convince him that his bad habits should 
be given up, as the causes of his disease, we would 
accomplish more for him than by prescribing all sorts 
of drugs for the cure of gout. In the plan of treat- 
ment all dangerous and inefficient remedies must be 
avoided, as they will only tend, by prolonged use, to in- 
tensify the disease and increase the disorder of the 
digestive apparatus. The therapeutics of gout will be 
reduced to very narrow limits if we wish to make use 
of the only remedy which is really of any service. Col- 
chicum is considered by many as a specific for this dis- 
ease, and it is the only substance the results of which 
are not too uncertain. The variability in its composi- 
tion and its activity, whether given in substance or in 
the various preparations which are in the market, have 
led many practitioners to abandon its use in favor of a 
more or less disguised expectant plan of treatment. 
Colchicum acts principally by its analgesic, deferves- 
cent, and cholagogue properties. The last of these 
explains the efficiency which it sometimes has in gout. 
The influence of the liver upon the production and 
excretion of urea is well known, and therefore all sub- 
stances which have a perceptible influence upon the 

19 



290 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

secretion of bile have an action which is no less ap- 
parent npon the coefficient of nric acid which is con- 
tained in the blood. Whatever be the mechanism of 
the action of colchicum, its advantageous results are 
undeniable, and it would be used more frequently were 
it not for the disadvantages which have been alluded 
to, in the specimens which are obtainable. None of 
these disadvantages appertain to colchicine. That 
which can be said of it in respect to the treatment of 
rheumatism is equally true with reference to gout. It 
is quite true that colchicum contains other alkaloids 
in addition to colchicine. What difference does that 
make, however, if colchicine contains all the advanta- 
geous and none of the disadvantageous properties 3 
Let us disregard colchiceine and the other alkaloids, of 
the properties of which we are ignorant, but continue 
to use colchicine, with the action of which we are ac- 
quainted, and of which we could not deprive ourselves 
without at the same time being disarmed in the pres- 
ence of two common and painful diseases, for which 
our patients demand a prompt relief. The curative 
treatment of gout means the treatment of the attack. 
But by attack we should not only understand the elim- 
inative process which is localized in the articulations, 
but also the visceral troubles, of variable form, which 
precede it or alternate with it. The attack is manifest 
when the quantity of uric acid becomes excessive. We 
should therefore strive to increase its elimination by 
all the passages when the organism begins to yield to 
the uricsemia. The diuretics, purgatives, and diapho- 
retics are useful so long as the attack is not well pro- 
nounced, but after that point has been reached the 
cholagogues alone will give results which are apprecia- 
ble. The attack is almost always announced by dis- 
order of digestion. If we are wise enough to interpret 
the cause of the dyspepsia, and do not allow the golden 
moment to pass by, we may succeed in aborting the 
attack by means of a simple purgative. Among the 






ELEMENTS OF DOSIMETRIC PRACTICE. 291 

different purgative agents, podophyllin should be given 
the preference on account of its decided cholagogue 
action. Five-granule doses, three or four in number, 
may be given at intervals of half an hour in the even- 
ing, before the final meal, and the following morning a 
small dose of Sedlitz Chanteaud will excite diuretic 
action and increase the purgative action of the podo- 
phyllm. Should we be unsuccessful in aborting the 
attack, or should we not have time to prevent it, w T e 
should begin the use of colchicine, administering two 
granules every two hours until either a purgative or an 
emetic effect has been obtained. This effect of the 
alkaloid should not frighten us, but, on the contrary, 
should be considered desirable, for it always coincides 
with a notable remission of all the symptoms. After 
this result has been obtained we should give only a sin- 
gle granule every two hours, and, should the diarrhoea 
or the vomiting still continue, we should give a single 
granule only once in four hours, and continue this plan 
until a cure has resulted. In cases in w T hich colchicine 
is not appropriate we can substitute aconitine, which 
has analogous but less decided properties for the relief 
of gout. After the attack is over we should institute 
a hygienic and pharmaceutical treatment of such a 
character as to prevent a new accumulation of uric 
acid, which would occur with the greater rapidity as 
the elimination of the deleterious urates at the previous 
attack was less complete. A few words may be said 
with respect to the pharmaceutical treatment. Acute 
gout should be treated with alkaline waters, w T ith the 
alternate use of three granules of the carbonate or the 
benzoate of lithia, three times daily. Atonic gout 
should be treated with the bitter tonics, three granules 
of quassine or euonymine being given before each meal. 
The variant consists in the use of calmatives and seda- 
tives, two granules of codeine, tannate of cannabine, 
or gelsemine, being given every half-hour should the 
pain become unendurable. For insomnia we should 



292 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

give three granules of bromide of camphor combined 
with three of Gregory's salt every quarter of an hour 
until we get the desired result. To patients who can 
not endure the morphine in Gregory's salt we should 
give croton chloral in similar doses. Dyspepsia should 
be treated by the daily use of Sedlitz Chanteaud, or by 
three granules of salicylate of soda or of quinine before 
each meal. Diminution in the quantity of urine voided 
should be treated by the use of one granule of digita- 
line every two hours during the inflammatory period. 
It should always be remembered that the renal func- 
tions in gouty patients are badly performed, and that 
an accumulation of medicinal substances in the blood 
may be easily accomplished. Still that should not 
prevent us from giving them the drugs which are suit- 
able to their condition, but the doses should be dimin- 
ished and their effect should be carefully awaited. 
This result is reached the more quickly as the func- 
tions are less perfectly accomplished. Should the 
other physiological effects of digitaline appear before 
its diuretic effect, three granules of asparagine may be 
substituted in its place every hour, or three of arbutine 
every two hours. The visceral manifestations in this 
disease are varied in character. The nervous system 
is most frequently affected, under the form of migraine, 
which should be treated with two granules of guara- 
nine every hour. The respiratory apparatus may also 
be attacked under the form of asthma, for which we 
should give one granule of aconitine every two hours. 
If the muscular system is affected under the form of 
myosalgia or paralysis, we should give two or three 
granules of veratrine every two hours. 

GOUT. 

f Exercise, temperance, alka- 
' Preventive and curative treat-! line mineral waters, Gar- 
ment during the remissions 1 bonate or benzoate of 
Dominant. ( I lithia. 

Curative treat- ( At the begin- j Podophyllin. 
ment during < ning . . { Sedlitz Chanteaud. 
the attacks . ( Subsequently Colchicine, aconitine. 






ELEMENTS OF DOSIMETRIC PRACTICE. 



293 



Variant. 



'Atony Quassine, euonymine. 

A ,. , { Gelsemine, tannate of canna- 

Articular pams . . . -j ^ine ' 

T . ( Bromide of camphor, croton 

Insomnia . . . . -j ch l ral, Gregory's salt. 

01iguria j Digitaline, asparagine, arbu- 



, Visceral gout , 



( Migraine 
-] Asthma 

f M\'OS£ 



tine. 
Guaranine. 

Aconitine, benzoate of soda. 
Veratrine. 



Haemoptysis. — See Broncho-pulmonary Hemor- 
rhage (under Hcemorrliage). 

Haemorrhage, Broncho-Pulmonary o — Pneumor- 
rhagia differs from bronchorrhagia only in respect to 
anatomical situation, prognosis, and extent — as to symp- 
tomatology and therapeutics, they may be considered 
in the same chapter. The fundamental cause of haemor- 
rhage consists in a want of equilibrium between the 
resistance of the walls of the vessels and the intravas- 
cular pressure. Since we can not change in an instant 
the structure of the vascular tunics, we are limited to 
the exercise of our influence upon their vitality, and this 
may take form by exciting the contractility of their 
muscular elements or by diminishing the intravascular 
pressure, either the energy of the current being re- 
duced or the crasis of the blood being modified. Ergo- 
tine or strychnine will fill the first indication, aconitine 
the second, aconitine and the depletives the third. 
Broncho-pulmonary haemorrhage is the result of hy- 
per emia or of disorganization of the walls of the ves- 
sels on account of ulceration, atheroma, etc. Hemor- 
rhagic hyperemia may be either active or passive. The 
former indicates aconitine, which opposes itself to the 
hemorrhagic molimen, that is, to the fluxion which 
appears in the form of hemorrhage ; one granule of it 
may be given every half -hour. The second requires digi- 
taline, to aid the heart in overcoming the stasis ; one 
granule may be given every hour, its action being re- 
enforced by one granule of the sulphate or arseniate 
of strychnine every quarter of an hour. The hemor- 
rhages which are due to lesions of the vessels require 



294: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

ergotine hypodermically, one gramme of water being 
used to dissolve ten granules of ergotine ; or the ergo- 
tine may be given by the mouth, three granules being 
given every quarter of an hour until the desired effect 
is obtained. The haemorrhages which come from large 
vessels will not readily yield to such means, for the 
large vessels are poorly supplied with contractile ele- 
ments ; still this is the best remedy which we have, and 
should be employed, for we have no means of deciding 
as to the size of the vessel from which the haemorrhage 
proceeds. The cardiac excitement which almost always 
accompanies these haemorrhages should be soothed by 
the use of three granules of veratrine every quarter of 
an hour until the contra- stimulant effect has been ob- 
tained. Although this agent acts indirectly, it acts 
more rapidly than ergotine. One or the other may be 
used, according to circumstances, but in severe cases 
we should use both. Adynamia, which may precede or 
follow haemorrhage, requires the use of two granules of 
strychnine every three hours. The cough, however 
mild it may be, is an obstacle to coagulation and to 
haemostasis. It should be soothed by the use of two 
granules of morphine every quarter of an hour. Dysp- 
noea, which indicates an obstruction in the air-passages 
by the blood which has been extravasated, may be 
quickly overcome by giving five granules of emetine in 
a teaspoonful of water every ten minutes, until vomit- 
ing or nausea results. The clots which are retained in 
the alveoli will, sooner or later, give rise to a circum- 
scribed pneumonia, which may terminate by suppura- 
tion or by ulceration, and is rarely susceptible of cure. 
The prognosis should therefore be a guarded one, and 
the physician should be in readiness to apply the 
proper remedies with the first evidence of phlogosis. 
The most useful means which can be used are the defer- 
vescents, the revulsives, and, during the period of sup- 
puration, iodoform with the arseniate of quinine, two 
granules of each being used three to five times daily. 






ELEMENTS OF DOSIMETRIC PRACTICE. 295 



jg /Hemorrhage from active ) Aconitine . 

W congestion . . . ) 

teH /Dominant. Haemorrhage from passive j. Dieitaline 

Id 

lesions 



aw . 



congestion 
Haemorrhage from vascular ) Ercotine 



/Cough Morphine. 

Dyspnoea .... Emetic. 
Variant. / Cardiac erethism . . Veratrine. 



q ^ \ Adynamia .... Strychnine. 

^ W ( Defervescents. 

2 VSubsequent pneumonia . •< Iodoform, arseniate of 

cq ( quinine. 

Haemorrhage, Cerebral. — How should cerebral 
haemorrhage be treated? The rational reply would 
seem to be that it should be treated both as a haemor- 
rhage and as a cerebral disease. Unfortunately, such a 
plan is not usually followed. Every one seems to for- 
get that apoplexy is one of the. forms by which cerebral 
haemorrhage is manifested, and hence, one of the prin- 
cipal elements of the disease being overlooked, the 
treatment always gives results which are uncertain, 
negative, or disastrous. How can we explain otherwise 
that, in a disease which is so severe and so well under- 
stood as to its pathogeny, its pathology, and its symp- 
tomatology, there should be so much disagreement 
among physicians, so that their plans of treatment, in 
which no one has any confidence, succeed rather by 
chance than as a result of conscientious and considerate 
application ? Trousseau, earnest though he was in seek- 
ing to find a specific for every disease, declines to indi- 
cate a treatment for sufferers from apoplexy, whatever 
be their condition, thereby showing his practical good 
sense, for apoplexy is a disease in which the excite- 
ment of any form of disturbance is not an insignificant 
matter ; and, as Trousseau recognized that all such dis- 
turbances must be useless, he declares that they must 
at the same time be dangerous. This is the only way 
that we can understand and explain the fact that so 
tireless a worker as Trousseau should advocate an ex- 
pectant plan of treatment, folding his arms in the pres- 
ence of so formidable a disease, while there was every 



296 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

inducement from without to attack it in some way or 
other. It would appear, however, that it is not neces- 
sary to make a very long search for the plan which 
should be adopted, in order to do what is possible for 
the relief of this terrible accident. Is not cerebral 
haemorrhage a true haemorrhage \ Is it not that which 
gives to the disease all its gravity % Is it not a drop of 
blood, more or less, effused into the brain, upon which 
the life or the death of the patient depends ? But, if 
cerebral haemorrhage is a true haemorhage, why should 
it not be treated as a haemorrhage % If in metrorrhagia, 
epistaxis, or haemoptysis, when the loss of a few grammes 
of blood, more or less, is not a matter of vital import- 
ance, the great object is to arrest the flow, why should 
we not have the same object in view in cerebral haemor- 
rhage, when death may result from the loss of one drop 
or even one globule of blood beyond the limit of endur- 
ance \ The first indication is, therefore, to arrest the 
haemorrhage. How % Why, just as one arrests other 
haemorrhages, with this conviction in addition, that there 
must be no experimentation in the matter. The sub- 
stance chosen must be an active haemostatic ; the prepa- 
ration which is used must be thoroughly reliable ; the 
avenue along which it is directed must insure the utmost 
freedom and rapidity of action. In menorrhagia we are 
in the habit of using ergot of rye, or its active principle 
ergotine, if we desire a rapid effect. This is the sub- 
stance, in fact, which will cause haemostasis of the 
parenchymatous vessels with the greatest rapidity ; it 
is, therefore, the remedy which should be employed in 
every case of apoplexy. While it is very active as a 
medicament, it has, however, two great disadvantages : 
The first, common to all vegetable preparations, is that 
it never contains fixed quantities of the active principle, 
so that it is never possible to say with precision just 
what result will be obtained from the use of a given 
quantity of a given preparation ; the second disadvan- 
tage is that it has a harmful influence upon the brain, 



ELEMENTS OF DOSIMETRIC PRACTICE. 297 

paralyzing the action of the nervous system upon all 
the organs.* 

Ergotine, while it does not have the second of these 
disadvantages, does have the first, f 

Ergotine, in fact, is not an alkaloid, but an extract 
which contains a variable quantity of its active princi- 
ple, and is capable of being decomposed by the digest- 
ive fluids. The ergotines of Bonjean and Yvon are the 
ones which represent this variability of action most 
faithfully. The ergotine of Catillon is the nearest ap- 
proach, as to uniformity of action, to the alkaloids, 
and should therefore be preferred. Ergotinine is an- 
other preparation which is available, but its great 
activity prevents its satisfactory use. How should 
ergotine be administered in order that its effect may be 
immediate ? The stomach can not be relied upon in a 
condition like this, for, with the existing prostration of 
the vital forces, we can not expect much in the way of 
absorption. In the apoplectic state, it may be reduced 
to the slow action of osmosis. Preference should there- 
fore be given to the hypodermic method, the medica- 
ment, in solution, being injected into the cellular tissue. 
The effect by this method is obtained more rapidly than 
by any other. A hypodermic injection of Catillon's 

* Chevallay, in autopsies made upon animals poisoned with ergot of 
rye, constantly found engorgements of blood in the skull, the spinal 
canal, and the venous system, which demonstrated the stupefying 
action of the drug. This fact caused Bonjean to rank ergot among the 
narcotics as the equal of opium. 

t Ergot of rye contains two very dissimilar active principles— a 
remedy and a poison. The first is ergotine, which possesses all the 
properties which are serviceable in obstetrics and as a haemostatic in 
general. It may be administered in as large doses as eight grammes 
without producing toxic effects. The second of these principles is a 
fixed, colorless oil, which is soluble in ether and insoluble in alcohol; it 
can be isolated perfectly from the first, and contains all the properties 
which affect sensation. The reader is referred for further information 
upon this subject to an article by Yan Renterghem in the " Compen- 
dium du Medecine dosimetrique," pp. 480-515. 



298 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

ergotine having been made, we can be sure of arresting 
the haemorrhage as quickly as possible, thus satisfying 
the causal indication. But, since this haemorrhage has 
taken place in cerebral tissue, its effects will disclose a 
characteristic physiognomy, and will call for a particu- 
lar treatment. The shock which is experienced by the 
central nervous organism will disturb its functions to 
the extent of suspending animal life. All vital acts 
which are accomplished under the influence of the 
cerebral centers are more or less affected ; and, by thus 
tending to change the condition of the blood, the effect 
of the change is experienced in a reflex manner by the 
nervous system. It is therefore of great importance to 
restore to the nervous centers their incitability, and to 
preserve at the same time the normal composition of 
the blood. In this emergency we can obtain assistance 
from caffeine and its salts, the arseniate of strychnine, 
the cutaneous revulsives, and the intestinal derivatives. 
All excitants and debilitants should be absolutely 
avoided, for we may be sure that these antagonistic 
substances will facilitate the way to the most unfavor- 
able result of apoplexy — that is, to cerebral softening. 
The treatment of apoplexy from cerebral haemorrhage 
may be formulated as follows, viz., we should inject 
into that side of the head in which, judging by the de- 
viation of the eyes, the head, and the tongue, the effu- 
sion has occurred, one gramme of a ten-per-cent solu- 
tion of Catillon's ergotine. Every quarter of an hour 
we should administer one granule of arseniate of strych- 
nine, and one of caffeine or its salts. Sinapisms of 
moderate strength should be applied to the arms, the 
thighs, the body, and the nucha. If at the end of three 
hours the patient has not regained consciousness, we 
should repeat the ergotine as well as the granules until 
the desired result is obtained. After the apoplectic 
condition has passed away, a dose of Sedlitz Chanteaud 
may be given to excite purgation, and the treatment 
may be begun which is designed to prevent the fever 



ELEMENTS OF DOSIMETRIC PRACTICE. 299 

which accompanies the reparative encephalitis. This 
will consist in the use of one granule each of aconitine, 
veratrine, and hydroferrocyanate of quinine every 
three hours. The haemostatic action should be kept up 
by the use of two granules of ergotine every three 
hours. The diet should be spare, but sufficient in 
quantity and quality to sustain the strength of the 
patient. After the fever has set in, defervescent treat- 
ment must be adopted, and regulated according to the 
intensity of the pyrexia. After the fever has been 
overcome, the treatment which is appropriate for pa- 
ralysis must be established by means of brucine and 
strychnine, and, to prevent recurrences of the attack, 
by ergotine. 

§ [Dominant. Haemorrhage . . . Ergotine. 

t-3 ^ I /Want of equilibrium in the ) Caffeine and its salts, ar- 

^ E2 ( [ nervous system . . ) seniate of strychnine. 

§ 2h j Constipation . . . Sedlitz Chanteaud. 

K^ 1 Variant. ( ( Veratrine, aconitine. hy- 

Fever -j droferrocyanate of qui- 

( nine. 
\ Paralysis .... Brucine, strychnine. 






Haemorrhoids. — Haemorrhoidal lesions always be- 
gin in the form of simple congestions. Eepeated ve- 
nous hyperemia results in dilatation of the veins, which 
continue to increase in size until true varices are 
formed. The congestion is due to causes which habit- 
ually give rise to congestion, but the dilatation of the 
veins, which really constitutes haemorrhoids, is caused 
primarily by a relaxation or atony of the vessels, which 
should be treated with two granules of ergotine and 
two of strychnine four times daily. The primary rectal 
congestion, as well as the hemorrhagic molimen, re- 
quires the use of one granule of aconitine every two 
hours. Haemorrhoids which are caused by the com- 
pressing action of abdominal tumors can be effectively 
treated only by the removal of the cause. When this 
compression is the result of a hardened fecal mass, the 
existing constipation may be corrected by the daily use 



300 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

of Sedlitz Chanteaud, which, in addition to its laxative 
property, has also the effect of stimulating the blood 
in respect to its affinity for oxygen, and of relieving 
the engorgement of the venous system. The pains 
which precede the hemorrhoidal attacks, which are 
more or less intense in character, and can not be defi- 
nitely located, may be soothed by using one granule of 
gelsemine or aconitine every hour. Dysuria will dis- 
appear if one granule of daturine is used every two 
hours until a number of doses have been taken. The 
spasm of the sphincter ani may be treated with the 
same agent, or with one granule of hyoscyamine every 
half -hour. Haemorrhage from the rectum is rarely 
beneficial, for it almost always increases the relaxation 
of the veins, and conduces to anaemia. Three granules 
of ergotine may be given for this condition every hour. 
A topical disinfectant application for haemorrhoids 
after they have reached a gangrenous or ulcerated con- 
dition may be made from vaseline thirty parts, pure 
iodine one part. The congestion of the rectum may be 
quickly relieved and the local vascular erethism as- 
suaged by the use of very hot enemata (40° to 45° C). 
Small pieces of ice introduced into the rectum will also 
give good results, but should be reserved as a haemo- 
static for obstinate haemorrhages from the rectum. 
The curative treatment for the hemorrhoidal tendency 
must be continued for a long time, and may be carried 
out after the following plan : In the morning a dose of 
Sedlitz Chanteaud dissolved in a large quantity of cold 
water may be given. Two granules of ergotine may be 
given before each of the two principal meals, and on 
alternate weeks the same quantity of sulphate of 
strychnine may be substituted for each dose. Upon 
retiring, two granules of aconitine may be given with 
two of digitaline. Stimulants should be abstained 
from, and very active exercise should be taken. If, in 
spite of the use of Sedlitz Chanteaud, constipation con- 
tinues obstinate, three granules of podophyllin may 



ELEMENTS OF DOSIMETRIC PRACTICE. 



301 



be used every evening, or ten of leptandrin every morn- 
ing with the Sedlitz Chanteaud. Grave hemorrhoidal 
lesions, whether due to the frequently recurring haem- 
orrhages, and the inflammations which are associated 
with them, or to the spasmodic or mechanical difficulty 
which has interfered with regular defecation, require 
surgical treatment. One of the most efficacious and 
least dangerous of such means consists in the forcible 
dilatation of the sphincter, the patient being anesthe- 
tized. 



03 




( Congestion .... 


. Aconitine. 


2 


'Dominant. 


-j Atony 


. Strychnine. 


o 




( Compression 


. Sedlitz Chanteaud 


w ( 




/ Pseudo-neuralgia 


. Gelsemine. 


O 




Dysuria .... 


. Daturine. 


^ Variant. 


I Spasm of the sphincter 


. Hyoscyamine. 


3 


\ Rectal congestion 


. Aconitine. 


^ 




Rectal haemorrhage . 


. Ergotine. 


w 




\ Gangrene, ulceration . 


. Antiseptics. 



Heart, Dilatation of the. — See Cardiectasis. 

Heart, Valvular Lesions of the. — There is no 
class of diseases which proves better than this the 
necessity that a true plan or system of therapeutics 
should be directed solely at vitality. In cases in which 
there are lesions of the cardiac orifices, therapeutics is 
completely disarmed in so far as any ability to modify 
them is concerned. It does intervene, however, and 
it is right that it should do so, but in a purely dy- 
namical manner. Thus it acts upon the cardiac mus- 
cle in its functional capacity, moderates or excites it, 
according to the exigencies of the condition, and so 
compensates in an indirect manner for the organic 
lesions which are manifestly irremediable'. In how 
many cases does endocarditis become chronic, after 
having passed a more or less acute stage — cases in 
which it might have been made to disappear without 
leaving any traces if the morbid phenomena had only 
been controlled at the beginning of the disease ! It is 
painful to see the time for intervention slip by without 
anything being done, and the means of relief reserved 



302 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

for the last stages of the disease. However active those 
means may be, they can then only give results which 
are ephemeral and insufficient. These lesions will be 
referred to in this article as the organic lesion of the 
orifices, without particular specifications, for the thera- 
peutic indications are the same, whether there be ste- 
nosis or insufficiency, whether the obstacle to the cir- 
culation is in one cavity or the other, or at the point 
of communication of the heart with the great vessels. 
This organic lesion requires to be studied in each of 
the morbid phases which it induces in the cardiac mus- 
cle. The resistance which the heart experiences in 
forcing the blood into the circulatory tree calls for 
efforts which are too great for the organo- functional 
equilibrium. The repetition of these exaggerated con- 
tractions gradually leads to muscular hypertrophy. 
The contractile elements, in order that equilibrium may 
be restored, are developed in excess, compensation 
being established at the price of a new lesion, which 
corrects the first. In cases in which pregnancy obtains, 
as the obstacle disappears at the time of delivery, the 
hypertrophy will also cease, and the cardiac muscle 
will regain its former structure and force. An exag- 
geration of dynamic capacity produces a lesion of 
structure, which disappears when the requirements are 
lessened. A clearer example (than this disease) could 
not be found of the process by which chronic diseases 
are established, nor a more evident indication of the 
course which should be followed in order to cure them, 
namely, to excite vital modifications. As the extent to 
which hypertrophy may be carried is limited, the organ 
will become fatigued should the resistance continue ; the 
muscular nutrition then becomes perverted, and granulo- 
fatty degeneration is the result. Then the contractile 
energy diminishes ; the heart is no longer able to force 
the blood with the same facility through the open ori- 
fices, nor to contract with sufficient force when the 
blood accumulates in its cavities, on account of the 



ELEMENTS OF DOSIMETRIC PRACTICE. 303 

insufficiency of the valves. The lesions are no longer 
compensated, and asystole begins. Therapeutic inter- 
vention has not the same effect in these two different 
phases of organic lesions, or the perturbations which 
they produce. They must, therefore, be considered 
separately. 

Compensatory Lesions. — The treatment for com- 
pensatory lesions is entirely of a preventive character. 
The patient experiences no suffering, and all the func- 
tions are performed with regularity. But the compen- 
satory process can not continue indefinitely, and will 
end the quicker as the heart becomes the more fatigued 
in its work. Hygienic methods exercise a preponderant 
influence in this condition. Every exciting moral im- 
pression, all functional excitement from physical over- 
work, should be carefully avoided. Exercise should 
not be violent, fatigue should be warded off as much as 
possible. A temperate climate in a level and shady 
locality should be selected for a home, and the patient 
should not be obliged to climb stairs. No stimulating 
food should be used — no coffee, tea, or alcohol. The 
diet should be a spare one, that the circulation may 
not be interfered with by dilatation of the stomach. 
The use of tobacco should be limited to a very small 
quantity, or should be given up altogether. The con- 
dition of the blood must be improved as much as pos- 
sible by the use of suitable food, or by giving one gran- 
ule of the arseniates of iron and antimony three times 
daily. Fatigue arising from overwork in the contrac- 
tility of the heart-muscle may be relieved by giving 
three granules of the arseniate of strychnine every 
evening as an incitant. Two to four granules of aconi- 
tine and digitaline, taken as calmatives every evening, 
will make the heart less sensitive to the action of stimu- 
lants, whether of internal or external origin, which can 
not be avoided in the course of ordinary life. Aconitine 
and digitaline, even in very small doses, have an effect 
which is decidedly favorable ; and this is not suprising 



304 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

when we reflect upon the bad effects which are some- 
times produced by apparently inoffensive stimulants 
like tea, tobacco, etc., notwithstanding the fact that we 
may have been using them habitually. 

Non- compensatory Lesions. — When, in spite of 
muscular hypertrophy, the cardiac impulse is no longer 
sufficiently forcible to overcome the obstacle at the 
mitral opening, the blood begins to stagnate, and this 
condition gradually extends to the entire circulatory 
system. From this stagnation, passive congestions in 
different organs result, their functions being profound- 
ly changed ; and the morbid state is the more aggra- 
vated as the congestions take place in important organs. 
The congestions induce dropsical conditions in various 
parts, and the patient usually dies as a result of these. 
Life ends, therefore, as the result of a series of per- 
turbations, the first of which is insufficiency of the car- 
diac energy, and the last the dropsical infiltration of all 
the tissues. By avoiding the first of these, by success- 
fully opposing the tendency to failure of the systolic 
power, we can prevent at the same time the appearance 
of all the other morbid phenomena. The fundamental 
indication is therefore to increase the energy of the 
heart by inciting its vitality, and by preserving its 
muscular integrity and the force of its innervation. 
Medication of a neurosthenic character should there- 
fore be established, with the precaution that incitation 
and not excitation is required, for the latter will give 
only a transitory advantage which will soon be followed 
by vital depression. When the period of compensa- 
tion has passed, we must try to restore the equilibrium 
by the use of heart tonics. Digitaline, strychnine, and 
guaranine are the means which should be used in com- 
bination or alternately, according to the exigencies of 
each case. Digitaline may be given in two-granule 
doses two or three times daily ; it may be associated 
with caffeine, live granules being given with each dose, 
and the quantity may be gradually diminished as the 



ELEMENTS OF DOSIMETRIC PRACTICE. 305 

pulse indicates greater vigor and regularity in the car- 
diac action. In order to sustain the regulating action 
of the digitaline, three granules of strychnine may be 
given every other night, five of guaranine being given 
on the alternate nights. Should the conditions of con- 
gestion become aggravated, the situation will become 
less hopeful, for all visceral complications are signifi- 
cant. Should stasis of the cerebral circulation occur, 
there will be a constant tendency to somnolence, for 
which we should give two granules of the valerianate 
or the arseniate of caffeine every half -hour, but without 
discontinuing the strychnine and digitaline. In some 
cases there is, on the other hand, persistent insomnia, 
for which relief must be given as speedily as possible. 
Two granules of cicutine may be given hourly, or three 
of croton chloral every half -hour. With very nervous 
people it may be better to give the bromide of camphor 
in three-granule doses every quarter of an hour until 
a hypnotic effect is obtained. Delirium in these cases 
may be best treated with digitaline, if the heart is sus- 
ceptible of its regulating action ; otherwise, two gran- 
ules of aconitine or hyoscyamine may be given three or 
four times daily. Ursemic accidents, which should not 
be confounded with the phenomena of delirium which 
result from cerebral stasis, are the result of renal lesions, 
and require to be treated with saline laxatives. Pul- 
monary congestion requires the use of revulsives, or 
one granule of aconitine combined with one of strych- 
nine every hour. The manner in which the urinary 
function of the kidneys is performed during the admin- 
istration of alkaloids must be carefully watched ; not 
with the view of discontinuing their administration, 
however, for they always give good results, but to cal- 
culate approximately the rapidity of their action, so as 
to be informed as to the probability of their accumula- 
tion, and to anticipate surprises, which, however, can 
never be irreparable if one practices the dosimetric 

method. This caution is necessary, because we can ob- 
20 



306 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

tain the desired result with much smaller doses than 
would be required if the kidneys were performing their 
function physiologically. Thus, in cases in which there 
is albuminuria and a considerable diminution in the 
quantity of urine discharged, not more than three or 
four granules of aconitine should be given ; while, if 
diuresis is in a normal condition, one granule may be 
given every hour until the desired result is obtained. 
Expectoration may be modified by the use of three 
granules of the benzoates at intervals of three hours, 
or one of atropine three times daily. Cough requires 
narceine, codeine, or Gregory's salt ; two granules may 
be given every half-hour. Haemoptysis should be 
treated with three granules of ergo tine every quarter 
of an hour, or, if the case is urgent, with hypodermic 
injections. Hepatic congestion may be rapidly modi- 
fied by the use of cholagogues. Two dessertspoonfuls 
of Sedlitz Chanteaud should be dissolved in half a litre 
of water and taken, and at intervals of an hour three 
granules of podophyllin may also be given. In twenty- 
four hours it will be found that the volume of the liver 
is much diminished. Likewise two granules of colchi- 
cine may be used hourly until a drastic effect has been 
obtained, but the result of this treatment is not so 
positive ; it is better to reserve it for those cases in 
which icterus is present. The regular use of Sedlitz 
Chanteaud should be advised during the entire course 
of these diseases, for, by its purgative and diuretic 
effect, it retards the progress of the lesions and tends 
to prevent complications. Dropsy is the natural con- 
sequence of the congestions which characterize heart 
lesions. On the one hand, we should seek to increase 
the tonicity of the heart, and, on the other, to excite 
such action as will produce the removal of the effused 
serum. The skin, the kidneys, and the intestines are 
the three avenues along which this action must be ac- 
complished. The means for producing diaphoresis are 
very uncertain, and should they be retained they may 



ELEMENTS OF DOSIMETRIC PRACTICE, 307 

exert a very harmful action upon the heart. In cases 
in which diaphoresis is indicated by so powerful an 
agent, we may use six granules of nitrate of pilocar- 
pine every ten minutes until the result is obtained, or 
five milligrammes may be given hypodermically every 
quarter of an hour. Aconitine will produce diuretic 
effects which are more constant, but at the cost of car- 
diac depression. Diaphoresis having been produced, 
we should at once give sulphate of strychnine in order 
to attenuate the disadvantages of the diaphoretics, and 
preserve the advantage which has been gained. Two 
granules may be given every hour. Diuresis may also 
be excited by a milk diet, which is especially advan- 
tageous if albuminuria is present, and by the use of 
arbutine at intervals of two hours. The same agents 
which were recommended to relieve hepatic congestion 
may also be used to excite the discharge of the dropsi- 
cal effusions by way of the intestines. While these 
means are being used we should be especially careful 
that the strength of the patient be not thereby drawn 
upon to any important extent, and that the digestive 
power be maintained, for otherwise asystole, which is 
always imminent, would be precipitated. Nothing need 
be said at this time concerning the various proced- 
ures in the way of local treatment for dropsy. Such 
methods include paracentesis, puncture, the use of 
capillary cannulse, etc., and are all sufficiently well 
described in the classical works on medicine and sur- 
gery. The object of this article is simply to indicate 
the method of treatment according to the dosimetric 
system. Lesions of the aortic orifice differ sufficiently 
as to their symptomatology and their treatment to 
merit separate consideration. When obstructive lesions 
of this orifice are compensated by hypertrophy, the 
resulting disturbance is not severe, but aortic insuffi- 
ciency will rapidly give rise to accidents, of which the 
principal ones are manifested by cerebral anaemia, and 
by lesions which are especially caused by distention 



308 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

and irritation of the nerves. The hypertrophy, in its 
compensatory role, must be sustained by heart tonics 
and sedatives, as was indicated for lesions of the mitral 
orifice. The cerebral anaemia, which is manifested by 
vertigo, intellectual debility, lipothymia, pallor of the 
face, etc., may be more effectually relieved by mor- 
phine than by any other drug. Either the hydro- 
bromate, the hydriodate, the hydrochlorate, or Greg- 
ory's salt may be chosen, two granules being given 
every half -hour. Abuse of this drug, however, neces- 
sitates larger and larger doses, until morphinomania is 
added to the disease which primarily called for relief. 
It should not be forgotten that the medication which 
has been recommended is only palliative, and that it 
must be reserved for those cases in which the anaemia 
has become dangerous or insupportable. A different 
salt of morphine should be used from time to time, 
relief should be sought occasionally by resorting to the 
horizontal position, or, again, five or ten drops of 
nitrite of amyl may be inhaled from a handkerchief, 
this variety of procedure being adopted so as to avoid 
the contracting of the morphine habit. Irritability of 
the disposition may be relieved by using three gran- 
ules of one of the alkaloids of opium with three of the 
bromide of camphor, three times daily. Thoracic neu- 
ralgia may also be relieved by morphine revulsives, 
iodoform, hyoscyamine, or the valerianate of atropine. 
Two granules of either of these agents may be used 
three times daily, or one granule every half -hour until 
the desired effect is obtained. Angina pectoris is one 
of the most dangerous complications of lesions of the 
aortic orifice. Pathologists do not agree in regard to 
its pathogenesis. All the indications lead to the belief, 
however, that it is merely a spasmodic neurosis of the 
heart, and this hypothesis is confirmed by the excel- 
lent results which follow the use of antispasmodics. 
One granule of hyoscyamine, daturine, or atropine, 
given every quarter of an hour, combined with three 



ELEMENTS OF DOSIMETRIC PRACTICE. 



509 



granules of the hydrobromate of morphine, or half a 
centigramme of the hydrochlorate of morphine and 
half a milligramme of the sulphate of atropine, dis- 
solved in water and injected subcutaneously at inter- 
vals of half an hour, will usually bring relief from this 
severe condition. Inhalations of nitrite of amyl and 
the prolonged use of electricity will also give good re- 
sults. Dyspnoea may also be relieved by the use of 
three granules of morphine, alone or in combination 
with the hydrobromate of cicutine or with aspidosa- 
mine. The last-mentioned drug may be used alone or 
with adonidine, which has a diuretic action. Both of 
them have been recently introduced into the dosimetric 
arsenal, being prepared in granules which contain one 
milligramme each. It is believed that they will be 
found indispensable in the treatment of diseases of the 
heart. Such are the most important symptomatic in- 
dications which are to be filled in the treatment of these 
diseases, which are as common as they are difficult to 
completely cure. 



ORGANIC DISEASES OF THE HEART. 



Lesions of the Mitral Orifice. 



Compensatory 
hypertrophy- 



Tonics 
Sedatives . 

Somnolence 
Cerebrai . . -{ Insomnia . 



Delirium . 

f Oppression 
J Expectoration 
1 Cough 
[ Haemoptysis 
Cholestasis 
Icterus 
j Oliguria 
} Albuminuria 
Means for exciting diaphoresis 
Means for exciting diuresis . 



p Purgation 



Pulmonary 



Hepatic . 
V Renal . 



Arseniate of strychnine, arseniate 
of iron. 

Aconitine, digitaline. 

Digitaline, caffeine, strychnine, 
guaranine. 

Valerianate or arseniate of caf- 
feine. 

Cicutine, croton chloral, bromide 
of camphor. 

Digitaline, aconitine, hyoscya- 
mine. 

Revulsives, aconitine. strychnine. 

Benzoates, atropine. 

Narceine, codeine, Gregory's salt. 

Ergotine. 

Sedlitz Chanteaud, podophyllum 

Colchicine. 

Sedlitz Chanteaud, arbutine. 

Aconitine, digitaline. 

Nitrate of pilocarpine, milk diet. 

Arbutine, adonidine. 
j Podophyllin, Sedlitz Chanteaud. 
( Colchicine. 



310 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Lesions of the Aortic Orifice. 

( Hydrobromate of morphine, atro- 
Angina pectoris . . . . -j pine, nitrite of aruyl, galvanic 

( current. 
Cerebral anaemia . . . . Salts of morphine, Gregory's salt. 

Neuralgia Morphine, iodoform, hyoscyamine. 

Dvsnncea i M° r P nme > hydrobromate of cicu- 

^ P ( tine, aspidosamine. 

Helminthiasis (Intestinal Worms). — There are 
three species of intestinal worms which are more fre- 
quently found than any others — lumbrici, oxyuri, and 
taeniae. The oxyuri, which have a length which does 
not exceed ten millimetres, are habitually found in the 
rectum of children, and from that organ they sometimes 
migrate into the vagina. The pruritus which is occa- 
sioned by their presence causes nervous irritation, and 
may lead to onanism. Our aim should therefore be to 
exterminate them. Since this affection is exclusively 
a local one, it should be treated by local means — that 
is, by enemata or suppositories. For children who are 
not utterly unmanageable, an enema, the basis of which 
is the following formula, may be used : 
^ Glycerinae, 

Aquae purae aa grammes xl. 

Calcii sulphidi in granulis . . . No. xx. 

Sig. : Triturate and use as an enema. 

If this means can not be conveniently employed we 
must use mercurial ointment, applied with the finger 
upon the surface of the anus and rectum. Irritation of 
the nervous system, caused by the pruritus of the anus 
or vagina, may be treated, in children one or two years 
of age, with one granule of the bromide of camphor 
every two hours. 

Lumbrici are usually twenty-five to thirty centi- 
metres in length. They are developed from ova in the 
water which is drunk by children rather than from 
improper alimentation. It may be assumed as a prin- 
ciple that some children are more susceptible to their 
development than others — that is, poor nutrition is fa- 
vorable to their development. The treatment consists 



ELEMENTS OF DOSIMETRIC PRACTICE. 311 

in the use of means which will poison the parasites, so 
that they may be ejected with the faeces. The most 
active agent for accomplishing this purpose, and the 
one which is most frequently employed, is santonine. 
The dosage should be large, for the object is to destroy 
the parasite in the medium in which it lives. Ten to 
fifteen granules of santonine should be given in the 
morning, and again in the evening, and the following 
morning a dose of Sedlitz Chanteaud should be given. 
No more doses of santonine should be administered, as 
it will irritate the intestine and produce a more serious 
result than would be produced by the worms. In ad- 
dition to santonine, the effect of which is sometimes 
uncertain, other alkaloids may be used, which also pro- 
duce good results, but are not to be considered purely 
as anthelmintics. Among such agents are picrotoxine, 
two or three granules of which may be used once daily, 
and sulphate of strychnine, one or two granules of 
which may be used once or twice daily, in place of the 
santonine. Two or three granules of the protiodide of 
mercury may also be used with advantage twice daily, 
and, unlike calomel, it will not be likely to produce 
stomatitis. 

Taeniae require a different mode of treatment from 
the other parasites. Kousseine and the tannate of pel- 
letierine are obtainable from the dosimetric arsenal for 
their destruction, but very large doses are required. 
The necessary dose of tannate of pelletierine is thirty 
centigrammes, which is the equivalent of three hundred 
granules. The latter may be taken in solution, and this 
method will often be the preferable one, on account of 
the prevailing prejudice in favor of the granules. Half 
an hour after taking the solution one or two spoonfuls 
of Sedlitz Chanteaud may be taken, especially if the 
patient is of a full habit. The paralyzing effect of the 
pelletierine upon the intestine almost always retards 
the action of the purgative ; it will therefore be advisa- 
ble to administer two or three granules of the sulphate 



312 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



of strychnine with the pelletierine, which will increase 
its action as a tsenicide and prevent the disadvantages 
which have been mentioned. Strychnine may also be 
used with podophyllin as a tsenicide ; two grannies of 
each may be given hourly, but the treatment should 
not be continued during more than twenty-four hours. 
While this plan of treatment is less certain than the 
previous ones, it will be found serviceable in some 
cases. Two days before a tsenicide is given, one should 
prescribe a laxative dose of Sedlitz Chanteaud, and for 
nourishment only liquids should be taken. By this 
plan the action of the tsenicide will not be interfered 
with by fecal contents of the intestine. Indications 
for the variant are occasionally present. Colic may be 
relieved by the use of two granules of tannate of canna- 
bine every half -hour. For vomiting, one granule of 
the sulphate of atropine should be given every hour. 
Ptyalism will yield to the use of one granule of hyos- 
cyamine every two hours. For insomnia two granules 
of croton chloral should be given every half -hour, and 
for convulsions three of the valerianate of zinc every 
half-hour. 

The dominant will suffice, in most cases, to dispel 
reflex phenomena, and they will cease entirely with the 
cause of the irritation. Sublata causa, tollitur effectus 
(if the cause is removed the effect will disappear). 

C Mercurial ointment, enemata con- 
taining sulphide of calcium, 
water, and glycerine. 

Strychnine, santonine, Sedlitz 
Chanteaud, picrotoxine. 

Tannate of pelletierine, Sedlitz 
Chanteaud, sulphate of strych- 
nine, podophyllin. 

Tannate of cannabine. 

Sulphate of atropine. 

Hyoscy amine. 

Croton chloral. 

Valerianate of zinc. 

Sulphate of strychnine. 

Hemicrania. — Certain diseases are considered in- 
curable simply for the reason that they resist all the 



Oxyuri 





^DOMIXANT. ( 


Lumbrici . 


< 






t— i 






H 1 




, Taeniae 


£f 










( Colic. 




Vomiting . 


H 


Variant. ( 


Ptyalism . 


K » "" 


Insomnia . 




Convulsions 






Paralysis . 



ELEMENTS OF DOSIMETRIC PRACTICE. 313 

means which have heretofore been used to cure them. 
This conclusion is not a logical one, for the impotence 
of our efforts does not prove the invulnerability of the 
disease, but the weakness of our attack. We should 
therefore distinguish, in therapeutics, those diseases 
which have merely resisted the means which have been 
used for their cure, from those which are quite insus- 
ceptible of being cured, so as to encourage experiment- 
ers in their investigations upon the action of drugs in 
certain fields which have heretofore been considered 
beyond the reach of medical aid. Fighting against the 
impossible is absurd, but all attempts in undiscovered 
territory are permissible and meritorious. 

Unfortunately, the habit of pathological anatomists 
has been to turn the attention of observers rather to- 
ward the irreparable results of disease than toward 
their first causes and the means for treating them, which 
has happened to the detriment of physiology and 
therapeutics. While the study of organic lesions has 
enriched the museums with the most exquisite histo- 
logical specimens, the chapter upon pathogenesis has 
remained stationary, and the literature concerning the 
treatment of diseases has not been enriched by a single 
durable formula ; for, remarkable as it may seem, the 
more one occupies himself with the pathological anat- 
omy of a morbid condition, the less he dreams of solv- 
ing the question as to its treatment. This is not alto- 
gether surprising, however, for, after a disease has been 
pronounced incurable by high authority, it is natural 
that those who admit such authority should withdraw 
from therapeutic investigation of the case and devote 
themselves exclusively to its anatomical aspects, thus 
transforming human medical science into special 
zoology. For a time, medical progress, like other dis- 
coveries, was due to chance. Experimenters took as 
guides in their investigations certain relations of simi- 
larity as to form, color, name, etc. The results were 
as ridiculous as could have been expected from such a 



314 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

plan. Now, thanks to the light which has been shed 
upon physiology by the work of learned men, and to 
the precise means which chemistry has provided in the 
alkaloids, of which pharmacodynamics teaches us the 
actual effects, therapeutic investigations, placed upon a 
rational basis, should lead to results as certain as they 
are useful. Dosimetry, enlightened by physiology, 
armed with definite chemical principles, and reassured 
by clinical experience, gives an example of investiga- 
tion in the direction of therapeutical progress, and the 
proof that such progress may be realized. It would ap- 
pear that, with a knowledge that there are perturbing 
forces which produce disease, and the discovery of the 
vital action of medicaments, the problem is reduced to 
its simplest form. Unfortunately, there is not unanim- 
ity of opinion in the battalion of physiologists, and a 
study of the divergences upon physiological questions 
might be written, like the one which Burggraeve has 
written with reference to the differences among allo- 
pathic practitioners. In the midst of the labyrinth of 
opinions upon the pathogeny of migraine, we must 
seek first for the thread of Ariadne in order to arrive 
at the truth. We shall no longer be obliged, then, to 
retain the word incurable, which is written by some 
pathologists upon the banner which floats above the 
domains of this disease. Jaccoud, at the end of his 
article upon migraine, states that art is powerless to 
abridge the duration of the sufferings of those who are 
its subjects. Littre and Robin, in their " Dictionary of 
Medicine," state that, in general, periodic migraine re- 
sists the action of medicaments. In spite of the great 
respect which the author has for the authorities which 
have been mentioned, he can not help finding the asser- 
tion of Jaccoud too positive. The physiology of disease 
can not be well studied if it is not based upon an exact 
and complete symptomatology. Now, in this as in all 
nervous diseases, nothing is so difficult to find as a 
satisfactory description of symptoms, not of those 



ELEMENTS OF DOSIMETRIC PEACTIOE. 315 

which characterize the migraine, but of those which 
constitute it. The mobility and the subjectivity of 
the greater number of nervous disorders, and the im- 
possibility of laying one's hands upon them, explain 
the insufficiency of the descriptions of the pathologists 
as to the manner in which they manifest themselves. 
It is not by means of one observation, but by repeated 
ones, that we can feel a certainty as to our knowledge 
of the different manifestations of different diseases. 
Thus we can find three distinct periods in the history 
of the physiology of migraine. In the first, which we 
can call the idealistic period, migraine is attributed to 
sympathy between the brain and the stomach. This 
opinion is defended by William Dale, who thus considers 
a simple etiological circumstance as a sufficient inter- 
pretation of the genesis of the disease. Clifford Allbutt 
and Niemeyer also think that migraine depends simply 
upon troubles of the abdominal viscera. This theory 
does not at all explain the nature of migraine ; it only 
informs us that these troubles may precede or accom- 
pany the attack in the head. Other authors refer to 
other organs as the point of departure for the symptoms 
in migraine, but without demonstrating its real nature. 
Tissot, Lebert, and Wepfer say that it is a neuralgia of 
the supraorbital nerve. Piorry localizes it primarily 
in the iris ; Hasse in the trigeminal ; Romberg and 
Calmeil in the cerebral substance. Anstie passes into 
the region of hypothetical anatomy when he assures us 
that this neuralgia is due to atrophic molecular irrita- 
tion of the roots of the trigeminal. Such is the period 
of hypothesis. With Du Bois-Reymond another period 
begins, during which observation which is more subject- 
ive in character makes its appearance. This learned 
physiologist observed in his personal exxDerience cer- 
tain symptoms which caused him to conclude that 
migraine is due to an exaltation of the cervical sympa- 
thetic. He observed in the course of the attack that 
the temporal artery became retracted, the countenance 



316 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

pale, the pupil dilated, the globe of the eye retracted, 
and that, by compressing the spinous processes of the 
vertebrse corresponding to the cilio-spinal region of the 
cord, a i>ain of a more or less acute character was excited. 
These symptoms were compared with the troubles 
produced in animals by electrization of the cervical por- 
tion of the sympathetic, and were found to be similar, 
thus leading him to the conclusion which has been stat- 
ed. In the opinion of Bu Bois-Reymond, therefore, 
migraine is an irritation — that is to say, a spasmodic 
condition of the organs which are involved. Mollen- 
dorf, on the contrary, holds an opinion which is op- 
posed to the foregoing. He found by examining the 
fundus of the eye that the arteries of the retina, in 
place of being contracted, were very much dilated ; 
this, added to the fact that the painful side of the head 
was frequently bathed in sweat, and that compression 
of the carotid diminished the pain, led him to the con- 
clusion that migraine, instead of being the result of 
irritation, was, on the contrary, the result of a tempo- 
rary paralysis of the cervical sympathetic. This con- 
clusion is diametrically opposed to that of Du Bois-Rey- 
mond ; but, as it is based upon unquestionable obser- 
vations, it should be accepted. The opposition between 
these two observers is rather apparent than real, and is 
perfectly comprehensible if we consider that Du Bois- 
Reymond's observations upon himself were made with 
difficulty in the course of an attack. The symptoms 
which he describes and interprets are referable there- 
fore to the beginning of the disease ; while Mollendorf, 
making his observations upon another individual, did 
not have the opportunity of being present at the first 
stage of the disease, and consequently his observations 
and the conclusions which he draws from them refer to 
its period of continuance or of decline. Hence, two dis- 
tinct phases must be conceded to migraine. The opin- 
ion which belongs to the third or eclectic period of the 
history of this disease is that which is held by Jaccoud, 



ELEMENTS OF DOSIMETRIC PRACTICE. 317 

Latham, Eulenburg, Gutmann, Poincare, etc. The 
theory of Leveing, which attributes the condition to a 
plethora of the nervous system, explains nothing and 
makes nothing clear. Hervez de Chegoin, by introduc- 
ing the vascular element into his explanation of certain 
symptoms peculiar to this disease, has taken a step in 
the right direction ; but he has not taken into consid- 
eration the facts observed by Du Bois-Reymond. Poin- 
care, of all authors, is the one whose explanation seems 
the most rational, and the most acceptable to the au- 
thor of this book, and he accordingly adopts the fol- 
lowing statement as to the genesis of migraine : The 
nervous fluid being disturbed in its regular distribu- 
tion, owing to different circumstances, the cervical sym- 
pathetic is irritated as a result, and tetanization of the 
contractile elements which depend upon it follows. 
The most common causes of this disturbance are ex- 
cesses at table, inanition, over-use of the eyes, very 
penetrating odors, vigils, prolonged intellectual labor, 
and changes in certain normal functions. This tetani- 
zation may be compared with the period of chill in 
fevers. The irritation extending to the smooth muscu- 
lar fibers of the vessels, causes their retraction, and, in 
consequence, ischsemia of the organs to which they are 
supplied. The sensorial and intellectual troubles at 
this period of the disease have no other cause. The 
semi- amaurosis, the difficulty in perceiving sounds, the 
intellectual feebleness, find in the weak condition of 
the blood, followed by the weak condition of the nerves, 
a plausible explanation. The pain which accompanies 
these symptoms is attributed to compression upon sen- 
sitive nerves by contraction of the walls of the vessels, 
and is analogous to the condition which obtains in 
uterine colic. In this first period the cause of the pain, 
therefore, is a spasmodic irritation which has its seat 
within the vascular walls. The duration of this first 
period varies greatly, but it is usually short. To the 
irritation the opposite condition follows, as is the rule 



318 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

in all nervous manifestations. To exaltation succeeds 
paralysis ; to tetanization, relaxation ; to ischsemia, con- 
gestion. By admitting the existence of vasodilator 
nerves, we are enabled to say that excessive irritability 
gives rise to paralysis of the vaso-constrictors, and in 
consequence to the preponderance of the vaso- dilators, 
which act when they are not in condition of equilib- 
rium with their antagonists. The phenomena peculiar 
to the second period are analogous to those of febrile 
reaction. It is at this time that dilatation of the retinal 
vessels may be observed, heat and redness of the coun- 
tenance, the ears, and the conjunctivse ; also the excre- 
tion of sweat, tears, saliva, of a large quantity of clear 
urine, and a large quantity of bile which, by entering 
the stomach, excites nausea and vomiting. Congestion 
of the retina and labyrinth produces subjective sensa- 
tions of light and auditive hyperesthesia. The hyper- 
semic brain becomes fatigued by the slightest intellect- 
ual effort. The pain in the head persists, but assumes 
another character and another origin. It is no longer 
the constrictive pain, such as was felt at the beginning 
of the attack, but a pain of an expansive character, 
which is suggestive of the throbbing of an artery, and 
should be attributed to the distention of the perivascu- 
lar tissue of the branches of the fifth pair. The longer 
duration of this stage, as compared with the first, sug- 
gests that in each attack there are paroxysms during 
which the phase of irritation gradually becomes less 
prominent, on account of the progressive obtunding of 
nervous irritability ; while, for the same reason, the sec- 
ond period develops increased sensitiveness to each 
successive exacerbation. This physiological analysis 
indicates clearly the treatment for each period. Some 
considerations may serve the better to establish our 
therapeutic plan, and confirm what is about to be said 
concerning the genesis of migraine. Every irritation 
of a part which is remote from that which is likely to 
be the seat of the disease is capable of aborting the at- 



ELEMENTS OF DOSIMETRIC PRACTICE. 319 

tack by nervous transposition and derivation of the 
blood. This fact is observed in the result of the inges- 
tion of alcohol, wine, or coffee, as well as in the appli- 
cation of cutaneous revulsives. Coitus will sometimes 
relieve migraine at the outset. All these means are 
antispasmodic, and accord with the results obtained by 
Piorry, who rubbed the eyelids with a concentrated 
solution of the extract of belladonna. If the patient is 
seen during this period, we should therefore advise the 
use of hyoscyamine, bromide of camphor, valerianate of 
caffeine, benzoate of ammonia, etc., in frequent doses, 
for this period is usually of short duration. In the 
second period or period of paralysis, as in that of febrile 
reaction, we should give strychnine to incite vital force, 
aconitine to relieve hyperemia, salts of quinine for 
their antiperiodic effect, and occasionally digitaline, if 
the pain is manifestly increased by arterial pulsations. 
These medicaments being designed to overcome the 
primary elements of the disease, other remedies, which 
are secondary, may be neglected. As the attacks suc- 
ceed each other with a certain regularity, we should 
not forget the preventive treatment, so as to guard 
against their recurrence. The diagnosis from an etio- 
logical standpoint is of great importance at this junct- 
ure, in enabling one to oppose to the determining and 
predisposing causes the means which will eliminate 
them. If hemicrania is idiopathic, the use of hyoscya- 
mine and valerianate of caffeine will overcome the sus- 
ceptibility of the sympathetic. Hydrotherapy and 
exercise are also very useful auxiliaries. One of the 
remedies which is often used, though its mode of action 
can not be explained, is guaranine, which gives excel- 
lent results in doses of two granules every half -hour, 
not only during the paroxysm, but also in the intervals. 
As a preventive to additional attacks, four granules 
may be used three or four times daily. This treatment 
should be continued for a long time, not being suspend- 
ed abruptly, but by gradually diminishing doses. Un- 



320 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

der the influence of guaranine, which certainly acts in 
a complex manner, the attacks become less frequent 
and less severe, and the disease becomes quite endur- 
able. These results show that Jaccoud has been un- 
wise in condemning patients to await with all possible 
patience the natural termination of their sufferings, 
the means of relief being within their grasp. In the 
the author' s experience, one lady who had been a great 
sufferer from migraine was freed from suffering for 
forty days by the aid of sea-baths and two granules of 
hyoscyamine daily. Another lady who has short but 
very frequent attacks, which sometimes recurred in 
the same day, was entirely relieved after having taken 
for eight days five granules of aconitine with five 
of arseniate of quinine daily. Hyoscyamine was 
tried in this case during the congestive period of 
an attack, but it only aggravated the pain. Gr. F. 
Brizuela reports, in No. 20 of the "Revista de Me- 
dicina Dosimetrica," published in Madrid, the case 
of one of his neighbors who had suffered, from the 
age of twenty years, with intermittent attacks of mi- 
graine, without definite periods for their recurrence, 
the attacks never lasting less than thirty hours. By 
taking one granule of aconitine and one of caffeine 
every quarter of an hour, he was able to limit the dura- 
tion of the attacks to two hours, at the end of which 
time he could eat without rejecting his food, as had 
always been his previous custom. Patients with this 
disease should know that progress has been made in 
therapeutics, and that they are indebted to the illus- 
trious author of dosimetry for this progress. What is 
true in respect to this disease is also true of others, 
which increases the obligation to him both for the pres- 
ent and the future. Physicians of whatever school 
should never forget the wise observation of Arago, 
"The man who uses the word impossible, in any de- 
partment outside of the mathematical sciences, is defi- 
cient in wisdom." 



ELEMENTS OF DOSIMETRIC PRACTICE. 321 



/r>~„™.^ m (Want of dynamic ) 



«*Sl ™l"ZZw^T". \ G 



8.2 



Hyoscyamine, bromide of cam- 
Spasm . . . \ phor, benzoate of ammonia, 



( valerianate of caffeine 
y ) Paralysis . . Arseniate of strychnine. 

' \ Congestion . . Aconitine. 
Ej q Periodicity . . Valerianate of quinine. 

\ Cardiac excitement Digitaline. 

Hepatitis, Interstitial {Cirrhosis of the Liver). — 

Sclerosis is preceded by a process of congestion which 
is necessary to the proliferation of the connective tis- 
sue. After the condition of hypertrophy has been 
reached, we can do nothing to effect a transformation 
in a retrograde direction. There are non-definite le- 
sions, pathological cicatrices, which it is beyond our 
power to remove. The opportunity for intervention by 
therapeutic means does not exist, therefore, when the 
disease is already established ; but, on the other hand, 
it does exist during the preparatory pathogenic period, 
when the condition of health is being transformed into 
that of disease, and when new portions of the organ 
are still undergoing attack. It is the successive aggra- 
vations of this condition which finally bring about the 
fatal issue. The course is clearly indicated — namely, 
to oppose the hypersemias and avoid their repetition. 
The dominant treatment for interstitial hepatitis may, 
consequently, be confused with that for congestion of 
the liver, which has been considered in another chap- 
ter. Aconitine should form the basis of the anti-con- 
gestive treatment, and it at once satisfies two important 
indications. The first refers to the hyperemia, which 
it may dispose of before there is new proliferation of 
connective tissue. The second refers to its action as a 
cholagogue, and thereby as an incitant to the secretion 
of bile. On the one hand, it diminishes vitality in the 
connective tissue ; on the other, it increases it in the 
parenchymatous tissue. It thus establishes an equi- 
librium, which resembles, as closely as may be, the 
physiological equilibrium. The hyperemia is to be 
attacked by administering aconitine in one -granule 
21 



322 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

doses every hour, or every half -hour in cases in which 
there is an excited state of the circulation in general, 
or pain and great increase in the volume of the liver in 
consequence of the increased flow of blood to the organ. 
In cases in which the hyperemia is not very pro- 
nounced, and the symptoms do not indicate extensive 
trouble in the circulation, there is still no reason for 
neglecting the condition, for, though the hyperemia 
be not extensive, it is an insidious condition, and is 
subject to frequent repetitions. In such cases aconitine 
should be given in moderation, but for a long time, per- 
haps, in two-granule doses two or three times daily. If 
the administration of the aconitine can not be contin- 
ued for a long time, it may be alternated with colchi- 
cine in similar doses, the effect of the latter being more 
decidedly cholagogue and less anti-congestive. Strych- 
nine should be used constantly, in order to fix the seda- 
tive effect which is produced by the aconitine, and also 
to prevent renewed hyperemia, which may be produced 
as a result of extreme vaso-motor atony. The attention 
of the physician should be fixed almost exclusively 
upon this portion of the pathological field, because it 
is the only one upon which the victory can be dis- 
puted. The professors of the official school, realizing 
the weakness of their instrumentalities in treating or- 
ganic lesions, proceed, like ourselves, to the treatment 
of the dynamic perturbations which precede them. 
Dujardin-Beaumetz says, concerning this subject : "In 
the interstitial inflammations which result in sclerosis, 
we can only reach the element of congestion which pre- 
cedes the organization of connective tissue. That which 
is true of the liver, in this respect, is true also of inter- 
stitial nephritis and of sclero-myelitis, in which the in- 
flammatory process is the same. After proliferation 
of the connective-tissue cells has been established, it is 
impossible to destroy the tissue by therapeutic means, 
and restore hepatic cells (to the liver), Malpighian 
bodies (to the kidneys), or nerve structure (to the spinal 



ELEMENTS OF DOSIMETRIC PRACTICE. 323 

cord)." The proliferation of the connective- tissue ele- 
ments causes displacement of the other anatomical ele- 
ments which enter into the organization of the liver. 
The vascular supply becomes insufficient, the blood- 
current becomes obstructed, passive congestion is estab- 
lished in all the ramifications of the vena porta*, and 
this congestion, by preventing intestinal absorption, 
and interfering with peristaltic action, results in ascites 
and diarrhoea, which attend cirrhosis of the liver sooner 
or later. In order to relieve the stasis, we should seek 
to strengthen the heart by the use of two granules of 
strychnine four times daily ; and, to relieve the press- 
ure upon the nervous system, either diuretics and 
purgatives may be used in moderation, or a smaller 
quantity of fluids may be ingested, thus offering less 
to the intestine for absorption. Sedlitz Chanteaud dis- 
solved in a little water will be found very serviceable 
at such a time. For constipation, three to four gran- 
ules of podophyllin may be given every evening, and 
a spoonful of Sedlitz Chanteaud every morning. Diar- 
rhoea, if not profuse, may be serviceable, and calls only 
for the use of strychnine to establish the advantage 
which the patient may have derived from it ; but, if it 
is excessive, it will make cachexia more pronounced, 
and profoundly debilitate the patient. It may be mod- 
erated by the use of three granules of morphine every 
two hours, and three of pepsin with each meal. The 
condition of acholia results from disturbances in the 
secretion and excretion of the biliary fluid. Iridine is 
also always successful in re-establishing the flow of the 
bile, and three to ^ve granules may be given three or 
four times daily. Ascites calls for the same treatment 
as stasis of the vena porta, from which it proceeds. 
We can only attempt to stop its rapid development by 
means of strychnine. When, in spite of all treatment, 
abdominal dropsy threatens the life of a patient, by 
reason of the dyspnoea which is occasioned by it, we 
must practice paracentesis, being careful to avoid the 



324 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

dilated veins upon the abdominal wall which compen- 
sate the embarrassed portal circulation. The patient 
should be advised to lie upon the side opposite that of 
the puncture ; the wound may be cicatrized rapidly 
without giving way to fistulse and inflammations of the 
skin. Paracentesis should be preceded and followed 
by the administration of two granules of ergotine and 
two of the sulphate of strychnine every two hours to 
prevent the renewed transudation of the dropsical fluid. 
Apart from those cases in which asphyxia threatens, 
parencentesis may be tried as a curative means, by rea- 
son of the favorable modifications which it induces 
upon the circulation and the respiration. To warrant 
the operation, however, there should be some proba- 
bility that the liquid will not be rapidly renewed, for 
the patient would bear with difficulty the loss from the 
blood of the serum, which would result from the re- 
development of the ascites. The age of the patient, 
the condition of his strength, the development of the 
collateral circulation, the degree of atrophy, these are 
the conditions which must be consulted in deciding as 
to the propriety of surgical intervention. Dyspepsia 
calls for quassine to stimulate contractility, and pepsin 
to replace the gastric juice, which has been changed in 
quality with the congested condition of its mucous 
membrane. Sedlitz Chanteaud may be used daily to 
relieve the digestive canal of any imperfectly elaborated 
food which it may contain. Cirrhosis, whether due to 
stasis of the portal circulation, which will facilitate 
enterorrhagia, or to that particular dyscrasia which is 
accompanied by hemorrhages at particular parts of the 
body, should be treated, in case haemorrhage does 
occur, with three granules of ergotine every quarter 
of an hour. If hepatitis is due to the action of malarial 
influence, haemorrhage may be more easily arrested by 
giving twenty granules of the sulphate of quinine three 
times daily. In enterorrhagia we should associate digi- 
taline with the ergotine, giving one granule every hour. 



ELEMENTS OF DOSIMETRIC PRACTICE. 



325 



If the haemorrhage proceeds from a dyscrasia, two 
granules of the salicylate of iron may be given every 
half-hour. 






Dominant. 



I Variant. 



Hyperemia 

/Stasis of the 

tion . 

Constipation 

Diarrhoea 
\ Acholia . 

Dyspepsia 

Dyspnoea 

Ilasmorrhage 



portal circula 



from sttibis 
from dvscrasia 



Aconitine. 

Strychnine, digitaline. 

Sedlitz Chanteaud. 
{ Podophyllin. 
\ Sedlitz Chanteaud. 

Strychnine, morphine. 

Iridine, euonymine. 
j Pepsin, Sedlitz Chan- 
( teaud, quassine. 

Paracentesis. 

Ergotine, digitaline. 
( Ergotine, salicylate of 
-] iron, sulphate of qui- 



Hepatitis, Suppurative. — Abscess of the liver 
may be caused by direct irritation, as by a biliary cal- 
culus, or by the irritation of septic agents brought from 
distant organs, as in cancer of the stomach, ulcerative 
colitis, etc. The discovery of the pyogenic microbes 
(streptococcus and staphylococcus) seems to be about 
to replace the old metastatic theories with more rational 
ideas, which will more satisfactorily explain the facts 
which have been observed. The dominant in hepatitis 
varies with the phase of the disease. In the dynamic 
period, when vaso-motor paralysis opens the morbid 
scene, we should give a granule of strychnine every 
half-hour to overcome the paralysis, and Sedlitz Chan- 
teaud to cause elimination of the irritating agents. The 
second indication will be filled by the use of five gran- 
ules of calomel every hour, or two of colchicine every 
two hours, until a cholagogue effect is obtained. When 
paralysis results in hyperemia, which is quickly trans- 
formed into inflammation, one granule of aconitine and 
one of strychnine should be used every half -hour until 
there is a remission of the symptoms. The chills which 
come at the beginning of the disease should be treated 
with the arseniate of strychnine until a reaction is ap- 
parent. The fever, which is almost always severe, pro- 
ceeds by intermittent or remittent attacks, with evening 



326 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

exacerbations. For the first we should give twenty 
granules of the salicylate of quinine at night, and for 
the remittent fever one granule of aconitine every hour 
during the attack, and the granules of the arseniate of 
quinine every hour during the remission. 

The point de cote, or pain in the liver, sometimes 
radiates as far as the shoulder, embarrasses the respira- 
tion, interferes with the patient's movements, and, by 
the increased flow of blood which it excites, increases 
the inflammatory condition. It should therefore be 
carefully antagonized with two granules of the hydro- 
chlorate of morphine every quarter of an hour. The 
dry cough which accompanies this condition, and is 
called the hepatic cough, may be soothed by the use of 
two granules of the hydrobromate of morphine every 
quarter of an hour. The vomiting, which is usually 
present in the first days of the disease, is the result of 
reflex irritation, and may be checked by the use of two 
granules of codeine, or two of the tannate of cannabine, 
every half -hoar ; it may also be due to direct irritation 
from the presence of the bile. In the latter case Sedlitz 
Chanteaud would be preferable to the sedatives. Icterus 
is only of secondary importance. In chronic hepatitis 
interference on account of this symptom is sometimes 
required, on account of its duration and the anxiety 
which it causes the patient. Two granules of calomel 
and two of arseniate of soda, given five times daily, 
will cause a rapid disappearance of this symptom. 
When there is no longer any doubt as to the presence 
of pus, surgical intervention will be necessary, whether 
the cavity be freely opened, with strict antiseptic pre- 
cautions, or a spontaneous discharge of the pus be fa- 
cilitated by the application of Vienna paste to the sur- 
face of the abdomen over the liver. The opening should 
be treated with antiseptic irrigations, drainage-tubes 
being retained in the wound. Whether the abscess 
open spontaneously or be opened by surgical means, 
internal treatment should precede and accompany the 



ELEMENTS OF DOSIMETRIC PRACTICE. 



327 



evacuation of the purulent accumulation. One granule 
each of iodoform and arseniate of soda every two hours 
to check suppuration, and two of arseniate of strych- 
nine every three hours to overcome adynamia and pros- 
tration, should be given regularly and persistently. 
The colliquative diarrhoea and hectic fever which ac- 
company chronic hepatitis leave little hope for a favor- 
able issue of the disease. In some cases the combina- 
tion of sulphate of strychnine and cotoine in two-granule 
doses every two hours, together with the principal 
treatment, will assist in bringing about a recovery. 
During the entire course of the disease a milk diet 
must be used almost exclusively, or at any rate there 
should be abstinence from the use of stimulating sub- 
stances. The relation which exists between gastro- 
duodenal irritation and inflammatory conditions of the 
liver is well known. 



H 

few 



f Vasomotor paralysis 
T> ^j Elimination of septic mat- 

I Hyperemia, inflammation 
/Chills . 
Intermittent fever . 

Remittent fever 
Pain in the liver 

Hepatic cough . 

Vomiting 

Icterus .... 

Suppuration . 

Adynamia 

Diarrhoea 



\ Variant. 



Arseniate of strychnine. 

Calomel, Sedlitz Chan- 
teaud. 

Aconitine, strychnine. 

Arseniate of strychnine. 

Salicylate of quinine. 

Aconitine, arseniate of qui- 
nine. 
\ Hydrochlorate of mor- 
\ phine. 

\ Hydrobromate of mor- 
l phine. 

Sedlitz Chanteaud, codeine. 

Calomel, arseniate of soda. 

Iodoform, arseniate of soda. 

Arseniate of strychnine, 
j Sulphate of strychnine, co- 
( toine. 

Hydrocephalus (Serous Apoplexy). — Dropsy of 
the brain may be either congenital or acquired. From 
the clinical point of view, the disease may be consid- 
ered as chronic and acute, the congenital form being 
the chronic one. Acquired or acute hydrocephalus 
alone calls for particular investigation. The principal 
causes of encephalic dropsy are either mechanical or 
dyscrasic. The first consist in obstacles to the venous 
circulation of the brain, and may be either within or 



328 ELEMENTS OF THERAPEUTICS AJSTD PRACTICE. 

without the brain ; the second include all the changes 
and all the diseases which modify the composition of 
the blood, and cause serous transudation. A third 
group of causes — the dynamic — should also be admitted, 
which consist in an atony or relaxation of the capilla- 
ries ; and this group is really the most important, for it 
may include the other two. Neither transudation from 
dyscrasic origin nor dropsy from venous stasis would 
be produced if the vascular tone were always sufficient 
to resist intravascular pressure. The principal domi- 
nant should therefore always attack this fundamental 
lesion, and ergotine and strychnine will perfectly satis- 
fy the indication. Two granules of each may be given 
every half-hour in acute cases ; three to five of each 
daily in chronic ones. For children, brucine is prefer- 
able to strychnine, because, as it is less active, its ac- 
tion may be better graduated. The variant should 
change with the variety of the hydrocephalus. Three 
varieties may be considered — the apoplectic, the rapid, 
and the slow. In the apoplectic form, the effusion may 
occur suddenly, or it may be added to a pre-existing 
effusion, so as to produce within a short time great 
compression upon the nervous centers contained in the 
brain. The symptoms include annihilation of the func- 
tions of the nervous system, which is described under 
the name of the apoplectic condition. The diagnosis 
between serous apoplexy and other apoplectic condi- 
tions almost always presents great difficulties. Ergotine 
is appropriate for serous as well as for sanguinolent 
effusions, and should be used in all cases ; but its regu- 
lar and rapid action can only be depended upon by 
using it hypodermically. If the differential diagnosis 
can be made, it will be proper to administer a two-per- 
cent solution of muriate of pilocarpine hypodermically, 
which will cause the removal of the serum rapidly and 
in large quantity. This result having been obtained, 
the ergotine and strychnine treatment must be contin- 
ued, in order to secure the advantage obtained. In the 



ELEMENTS OF DOSIMETRIC PRACTICE. 329 

rapid form of hydrocephalus, there is more time for 
therapeutic intervention. The treatment is the same, 
but the alternating conditions of excitation and depres- 
sion also indicate quinine. In the period of excitation, 
three granules of the hydrobromate may be given every 
half-hour, and in the period of depression, the valeri- 
anate in similar doses. Yertigo often accompanies the 
slow form of hydrocephalus. It should be treated with 
caffeine, in three-granule doses every hour. Aside from 
the action of caffeine upon the cerebral functions and 
its dynamophoric properties, it also acts as a diuretic. 
The general paralysis and obtuse sensations, which are 
the result of compression of the brain, may be modified 
by the use of brucine in three-granule doses every two 
hours. Convulsions, which may interrupt the monot- 
ony of the slow form of the disease, should be treated 
with bromide of camphor in two-granule doses every 
half-hour, combined with brucine and sulphate of 
strychnine, one granule of each every hour. Treatment 
which is designed merely to remove the serum should 
not be practiced, because it only tends to increase the 
vascular atony. If, however, it is the only thing which 
can be done, we should first strengthen the patient 
with neurosthenic means, and then use purgatives, diu- 
retics, sudorifics, etc. 



m 

g \ Variant. 

o 

Q 



y Convulsions 



g /Dominant. Vascular atony . . j Er |^ e ' 

/Serous apoplexy 
Excited condition . 
Alternating with depres 

sion 
Vertigo . 
General paresis 



Pilocarpine. 
Hydrobromate of quinine. 

Valerianate of quinine. 

Caffeine. 
Brucine. 
Bromide of camphor, sulphate 



£h N ' ' ' ) of strychnine. 

Hydrophobia. — Thanks to the labors of Pasteur, 
we now know that hydrophobia is due to the develop- 
ment of a microbe within the nervous system, which 
microbe he has discovered and cultivated. The pre- 
ventive treatment, consisting in inoculation, thus be- 
comes a very simple matter, and justifies the hope that 



330 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

hydrophobia in man may in the f uture be of exception- 
al occurrence. 

Unfortunately, elements are still wanting which ap- 
pertain to the preservative value of attenuated virus 
which has been the means of inoculation after a bite 
has been received, and still more so in those cases in 
which hydrophobia actually exists. The preventive 
dosimetric treatment should have for its object opposi- 
tion to the development of the virus and diminution of 
the nervous impressionability of the patient, so as to 
put off or at least to diminish the violence of the at- 
tacks when the disease exists. After the bite itself has 
been suitably treated, we should endeavor to destroy 
the microbes, which may not have been reached by the 
local treatment, by saturating the organism with sul- 
phide of calcium, which is the best parasiticide with 
which we are acquainted. The drug should be given 
with great regularity, and with as much persistence as 
if an eruptive fever were being treated, one or two 
granules being given every quarter of an hour, and the 
patient being kept under its influence two to four days, 
according to the probabilities with reference to the 
inoculation, the number, situation, and gravity of the 
bites being considered. We should also give alternately, 
in two-granule doses twice daily, atropine and cicutine 
as long as is necessary to insure complete tranquillity. 

After the disease has manifested itself, the dominant 
will be five granules of the sulphide of calcium every 
half -hour, to neutralize the virus which is disseminated 
through the nervous system ; atropine being added in 
one-granule doses every half -hour until its physiologi- 
cal effect is obtained, and then being renewed after this 
effect has passed away. As the virus changes the 
character of the secretions by its own nutrition and the 
modifications in nutrition which it brings about in the 
organism, its elimination by all the emunctories should 
be favored. For this end diuretics and purgatives 
should be given, and the indication will be fulfilled by 



ELEMENTS OF DO SIM ETUI G PRACTICE. 



331 



using a spoonful of Sedlitz Chanteaud every two hours. 
During the period of melancholy, when the nature of 
the disease is suspected by the patient, the dominant 
should be used with great activity, for it is only during 
this stage that it can be used with regularity. The de- 
pressing character of the morbid phenomena of this 
period calls for the use of the salicylate of ammonia in 
three-granule doses every hour, and this in addition to 
its exciting action will also aid the action of the domi- 
nant. In the second period, the readiness with which 
spasms are excited being one of the most frequent 
causes of the patient's sufferings, we should, if possible, 
re-enforce the action of atropine with daturine, or with 
bromide of camphor if a further use of the mydriatics 
is not advisable. Atropine may be given in one-granule 
doses every half -hour until the physiological effect is 
obtained ; camphor or croton chloral may be used in 
three-granule doses every half-hour until a sedative 
effect has been obtained. The paralytic period which 
follows the great loss of vital force indicates hypophos- 
phite of strychnine and phosphoric acid in doses con- 
taining two granules of each every half -hour. When 
pharyngeal or other spasms of the respiratory passages 
interfere with the ingestion of medicaments, we must 
use hypodermic and rectal injections. This plan of 
treatment may seem too energetic, but unfortunately 
the author has seen in three fatal cases that death is 
the rule of this disease, which is so rapid that it must 
be attacked unsparingly and without hesitation. 
Whatever plan of treatment be devised, experience has 
proved that the best chances for success exist no more 
after the melancholic period has passed. 



f Parasitic element . 

D »--H^tt a S,- the prod 
I ucts of elimination 
f Period of melancholy 
Period of spasm . 



Variant. 



Period of paralysis 



Sulphide of calcium. 
Atropine. 

Sedlitz Chanteaud. 

Salicylate of ammonia. 
Daturine, bromide of camphor. 
Hypophosphite of strychnine, 
phosphoric acid. 



332 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Hyperemia, Meningo-spinal. — Meningo- spinal 
congestion sometimes occurs as an independent and 
isolated condition ; it is usually united to other 
lesions, however, especially to spinal meningitis. The 
dominant consists in the use of aconitine, which, in 
addition to its effect upon the hyperemia, is an ex- 
cellent sedative to the nervous centers, either directly 
by its sedative action upon the nerves, or indirectly 
as a moderator of the circulation. The congestion 
may be active, supplementary, or passive. Active 
congestion is produced by the irritant action of infec- 
tious agents, as occurs, for example, in variola. The 
sulphide of calcium should be combined with aconitine, 
to antagonize simultaneously the physio-pathological 
and the etiocratic elements. When the congestion is 
due to the action of cold, diaphoretics are indicated, 
and one granule of aconitine with ^ve of pilocarpine 
may be given every quarter of an hour until the desired 
effect is produced. If the congestion is due to the ac- 
tion of heat, the same diaphoretics may be used, and 
Sedlitz Chanteaud may be added for its refreshing in- 
fluence upon the blood. The supplementary conges- 
tions which may be due to suppression of the menses 
will yield to the action of veratrine, which at the same 
time will tend to re-establish the suppressed function. 
Two granules of veratrine should be given with one of 
aconitine, every half -hour, or every hour, according to 
the urgency of the case. If the congestion is due to 
the suppression of a hemorrhoidal flux, the daily use 
of Sedlitz Chanteaud should be resorted to, together 
with three granules of bryonine every two hours. The 
passive congestions which are due to obstruction in the 
venous circulation may be treated in different ways. 
The end which should always be sought is the restora- 
tion of the circulation to its normal condition, and the 
stimulation of the vessels of the cord, which have been 
dilated and paralyzed by the excessive pressure of the 
volume of blood which they contain. To accomplish 



ELEMENTS OF DOSIMETRIC PRACTICE. 333 

this end, two granules of digitaline and two of the sul- 
phate of strychnine should be given two to four times 
daily. Intense pain in the lumbar region should be 
treated with one granule of hyoscyamine and one of 
cicutine every half-hour until relief is obtained. 
Retention of urine resulting from torpor in the 
innervation of the excretory apparatus calls for the 
use of hypophosphite of strychnine, three granules of 
which may be given every hour ; in some cases it will 
be well to add a granule of daturine every hour until 
mydriasis results. For the paraplegia, two granules of 
phosphoric acid, three to five times daily, will be ap- 
propriate ; or, in recent cases, three granules of ergotine 
every two hours. Cold, warm, or hot baths will be 
found useful as auxiliaries to this plan of treatment. 

MENINGO-SPINAL HYPEREMIA. 

Dominant. 
Hyperaemia Aconitine. 

Causal Variant. 

A^f,-,^ ™r,™o ( From infection . . Sulphide of calcium. 

tiSS l \ From C0ld * ' * titrate of pilocarpine. 

* ( From heat . . . Aconitine, Sedlitz Chanteaud. 

[From cessation of the [ v D ™tr'n n 

Supplementary J menses . . . f veratrme - 

congestion . 1 From cessation of the / jr; nu t. ^ i 

* [ hemorrhoidal flux . [ Sedlitz Chanteaud, bryonme. 

Passive rone-ps ( From obstruction in the j_ Digitaline, sulphate of strych- 
*.:„_ ° s venous circulation . \ nine. 



tion 



From muscular efforts . Ergotine. 
Symptomatic Variant. 



.Radiating lumbar pains . . . Hyoscyamine, cicutine. 

Retention of urine . ... j D f t ry C Tnine yP ° Ph0Sphite ° f 
Paraplegia Ergotine, phosphoric acid. 

Hyperkinesia, Cardiac (Palpitations of the 
Heart). — Exaggeration in the number or the force of 
the cardiac pulsations constitutes hyperkinesia. But, 
in order that this may amount to a condition of dis- 
ease, the patient must be conscious of his trouble, and 



334: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

really suffer from it. The condition appears to be a 
convulsive one of the cardiac muscle, which affects, to 
a greater or less degree, the entire organism. What- 
ever the cause of the palpitations may be, the essential 
lesion is a dynamic perturbation, for the effect is not 
a constant convulsive condition of the heart ; neither is 
the patient conscious of his trouble at all times. To 
relieve the irritability of the heart, or the nervous cen- 
ters which animate, should be the object of treatment, 
and consequently the dominant established upon this 
hypothesis should be associated with the treatment for 
the other lesions. One granule of strychnine, with one 
of hyoscyamine, three or four times daily, by restoring 
the dynamic equilibrium, will usually constitute the 
principal treatment, and for many cases it is all that 
will be necessary. There are particular indications for 
the mechanical modifications caused, in some cases, by 
a diminution, and in others by an increase of pressure. 
In the first case we should give two or three granules 
of the arseniate of iron three times daily to increase the 
volume of the circulating fluid, and two or three gran- 
ules of the arseniate of strychnine three times daily to 
increase the vascular tone and restore the normal press- 
ure. In cases of the opposite character, two granules 
of digitaline and two of sulphate of strychnine should 
be given two or three times daily, to bring about an 
equilibrium between the force of impulsion and the 
vascular pressure. The changes in the innervation 
consist of vaso-motor atony, which calls for two or three 
granules of ergotine and an equal quantity of the ar- 
seniate of strychnine three times daily, and nervous 
irritability, which may be quieted by the use of three 
granules of the monobromate of camphor three or four 
times daily, or by similar quantities of codeine. Modi- 
fications in the quantity and quality of the blood have 
a noteworthy influence in the production of hyper- 
kinesia. Chlorosis, anaemia, and plethora are fre- 
quently the cause of palpitations. Chlorosis and anse- 



ELEMENTS OF DOSIMETRIC PRACTICE. 335 

mia should be treated with two granules of the valeri- 
anate of iron and two of arsenious acid three times 
daily, while plethora, as a cause of hyperkinesia, will 
yield to the influence of Sedlitz Chanteaud and two 
granules each of aconitine and veratrine three times 
daily. The hygienic treatment will consist in pro- 
tecting the heart from anything which may tend to 
irritate it. Tea, coffee, alcohol, coitus, moral emo- 
tions, and tobacco are all agents which tend to the 
production of palpitations, and should be careful- 
ly abstained from under any and all circumstances. 
The symptomatic variants will rarely require our at- 
tention in the treatment of this condition ; it will be 
occupied, in the main, with the causal indications. 
Sometimes, however, particular symptoms will furnish 
the occasion for particular treatment. Thus, should 
dyspnoea be a source of annoyance to the patient, we 
may give two granules of the hydrobromate of cicutine 
every half-hour until relief is obtained. Lipothymia 
will demand the immediate use of one granule of phos- 
phoric acid every five minutes. The periodic occur- 
rence of the attacks which is sometimes noticeable will 
indicate the use of three to five granules of the hydro- 
bromate or the valerianate of quinine three times daily. 
Other indications will sometimes arise, and they must 
not be neglected. For example, helminthiasis may 
cause palpitations, which will be more or less trouble- 
some, and for this condition ten granules of santonine 
should be given every evening. Constipation may also 
be a complication, and this should be treated with three 
to five granules of podophyllin every evening, or by 
the daily use of Sedlitz Chanteaud. There are also 
reflex palpitations, which are always due to nervous 
irritability, besides many other varieties which are too 
well known to require particular mention. It may be 
desirable, however, to call attention to those which are 
caused by gastric disorders, especially such as arise 
from dilatation or flatulence. 



336 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



/Dynamic modifi- 
cations . 

Mechanical modi- 
fications . 



Modifications of 
innervation . 



Modifications 
the blood 



HYPERKINESIA. 

Want of dynamic equi- \ 
librium . . . | 

Diminished pressure 
Increased pressure . 
Vaso-motor atony . 
Nervous irritability . 
Anaemia . 
Plethora . 



Dyspnoea . 
Lipothymia 
Periodicity 
Helminthiasis 

, Constipation* 



Hyoscyamine, strychnine. 

Arseniate of iron, arseniate 
of strychnine. 

Digitaline, sulphate of 
strychnine. 

Ergo'tine, sulphate of 
strychnine. 

Bromide of camphor, co- 
deine. 

Valerianate of iron, arseni- 
ous acid. 

Aconitine, veratrine, Sed- 
litz Chanteaud. 

Hydrobromate of cicutine. 

Phosphoric acid. 

Valerianate of quinine. 

Santonine. 
j Podophyllin, Sedlitz Chan- 
{ teaud. 



Hypertrophy, Cardiac— Hypertrophy of the heart 
is the result of an irritation of its muscular tissue, of a 
nutritive character, resulting from an excess of work, 
which may be caused by an interference in the circula- 
tion of the blood propelled by the ventricles, or by an 
excitation which is purely of nervous origin. Hyper- 
trophy, in so far as it is a compensating lesion, is a 
salutary modification of the normal structure, an effort 
to restore the physiological equilibrium by adapting 
the organ to its function, and to that extent it should 
be appreciated. Sometimes, however, it exceeds the 
necessities of the case, and this excess becomes a dis- 
ease which we must moderate, not only because it im- 
poses a useless restraint upon the patient, but because 
we ought to reserve the proliferative force of the organ- 
ism for that epoch — which may not be remote — when 
we shall need its assistance. Hypertrophy which fol- 
lows hyperkinesia should always be antagonized, be- 
cause it is a useless change, an aggravation of its origi- 
nal cause, and far from being a compensatory condition, 
as it is when valvular lesions are present. Hypertrophy 
of the contractile elements of the heart maybe modified 
by veratrine, an agent which has the greatest influence 



ELEMENTS OF DOSIMETRIC PRACTICE. 337 

upon muscular nutrition. It may be given in large 
doses, which should be regulated, however, by the state 
of the pulse and the cardiac force. In general terms, 
two to three granules may be given three to five times 
daily, until the state of the pulse indicates its with- 
drawal. Excess of vascular pressure, caused by con- 
gestion within the cranium or elsewhere, should be 
treated with aconitine and Sedlitz Chant eaud. Two 
granules of aconitine three to four times daily will be 
equivalent to a bloodletting, and Sedlitz, by the transu- 
dation which it provokes to the surface of the intestinal 
mucous membrane, will diminish the vascular pressure 
and regulate all the functions. A dessertspoonful may 
be given every morning. Epistaxis may be of service 
in relieving cephalic hyperemia ; but, if this natural 
means of abstracting blood is not indicated, we should 
use ergotine in doses of three granules every half-hour. 
Vertigo should be treated with purgatives and the 
valerianate of caffeine. The use of Sedlitz Chanteaud 
should also be insisted upon, and its effect may be in- 
creased by using three to five granules of podophyllin 
every evening. Caffeine should also be used with mod- 
eration — that is, in doses of two granules every quarter 
of an hour. Aconitine is equally useful for vertigo, 
especially when this is accompanied by headache, one 
granule being given every half-hour. A hard and vi- 
brating pulse, denoting an excitation of cardiac con- 
tractility, and a considerable increase in arterial press- 
ure, calls for Sedlitz Chanteaud and emetine, two gran- 
ules of the latter being given every hour until the cir- 
culation is quieted. Palpitations may be controlled by 
using two granules each of digitaline and arseniate of 
antimony, two to three times daily. Dyspnoea and 
thoracic oppression, indicating broncho-pulmonary con- 
gestion and weakness of the respiratory apparatus, 
should be treated with three granules each of apomor- 
phine and nitrate of pilocarpine every two hours. After 
the functional troubles have been quieted, we should 

22 



338 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



m 




Muscular hypertrophy 
/Excess of vascular pressure 
Cephalic congestion . 
Epistaxis . 




\ Variant, i 


Vertigo . 

Hard and vibrating pulse . 


W 




Palpitations 
^Dyspnoea . . . . 



seek to preserve the physiological equilibrium and pre- 
vent fatigue of the heart by giving two to four granules 
of aconitine every evening, with an equal quantity of 
digitaline and arseniate of strychnine, and in the morn- 
ing a small dose of Sedlitz Chanteaud. By these means 
we can keep the patient in a relatively comfortable con- 
dition for a very long time. The hygienic treatment 
should, of course, harmonize with the pharmaceutical. 

Veratrine. 
j Sedlitz Chanteaud, aconi- 
\ tine. 

Ergotine. 
j Podophyllin, aconitine, 
( valerianate of caffeine. 
Sedlitz Chanteaud, eme- 
tine. 
Digitaline, arseniate of 

antimony. 
Apomorphine, nitrate of 
pilocarpine. 

Hysteria. — Hysteria is a type of affections which 
are purely of nervous origin, and is caused by a par- 
ticular predisposition to a want of dynamic equilibrium. 
An attack may be caused by a perturbation of any 
character whatsoever, and it may take a thousand 
forms, from a simple change of mood to the most vio- 
lent convulsions, ecstasy, etc. The general treatment 
of hysteria should consist, therefore : 

1. In restoring the equilibrium of the vital dynamic 
condition. 

2. In suppressing the exciting causes. 

The first indication may be filled by the observation 
of a rigorous physical and moral regimen, and by the 
use of the proper alkaloids. Aconitine, digitaline, hy- 
oscyamine, and strychnine should be given every even- 
ing in doses of two to four granules of each, the treat- 
ment being commenced, however, by using the smallest 
quantities of each, and gradually increasing it until the 
quantity indicated has been reached. This treatment 
should be continued a long time, and the dosage may be 
diminished as the symptoms are ameliorated. Should 



ELEMENTS OF DOSIMETRIC PRACTICE. 339 

congestion occur frequently, we should press the ad- 
ministration of aconitine ; should the heart be very- 
excitable, we should adopt the same course with digi- 
taline ; if the patient should be very feeble, we should 
increase the quantity of strychnine ; if spasms are fre- 
quent and constitute the principal trouble, we should 
give without hesitation a very strong dose of hyoscya- 
mine, provided there is no peculiarity on the part of 
the patient to contra-indicate its use. The second indi- 
cation, to suppress the exciting causes, is equally im- 
portant. Everything should be avoided, therefore, 
which would excite an attack — not only an attack of a 
pronounced character, but also one which, from its 
slight intensity, might be overlooked. Frequently hys- 
teria is caused by constipation, ulceration of the neck 
of the womb, laborious digestion, stimulating or innu- 
tritious food, or entozoa. The treatment should be fol- 
lowed up without interruption or abatement of care. 
It must not be forgotten that one attack predisposes to 
others, and that the longer the interval between con- 
secutive attacks, the better will be the prospect of a 
radical cure. With advancing age, hysteria will disap- 
pear ; the same result may also be obtained by proper 
treatment : in both cases a certain period of time is an 
indispensable element of success. During the attacks, 
there is little that the physician can do. After having 
arranged the patient so that she can not harm herself 
and can properly perform the different physiological 
functions, he may interfere in the manner which is pre- 
scribed in the various classical treatises ; but he will 
rarely be able to shorten the duration of the attack. 
He may reach the conclusion that an aborted attack 
never leaves a patient in good humor ; and, on the other 
hand, by a kind of disastrous compensation, exposes 
her to a series of violent attacks. It would seem as if 
the system needed to get rid of a superfluity of force, 
which results in an absence of dynamic equilibrium, 
before that equilibrium can be restored. There are 



340 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

cases, however, in which intervention is required, more 
for the sake of the patient's family than on account of 
the exigencies of the disease. In such cases we should 
give two granules of bromide of camphor every half- 
hour, dissolved in a teaspoonful of cold water or similar 
quantities of piperine. Some symptoms require par- 
ticular treatment by means of local applications, such 
as metallotherapy, electricity, hydrotherapy, etc. By 
treatment with alkaloids, we can often obtain results, 
however, which could not be obtained by external 
treatment. We shall therefore indicate in a few words 
the principal agents which may be used to oppose the 
different symptoms. One important symptom of hys- 
teria consists in contractures, which are sometimes very 
persistent, and we should never count upon their spon- 
taneous resolution. Success in treating them will be 
influenced to a great degree by the promptness with 
which treatment is begun. One granule of hyoscya- 
mine should be given every quarter of an hour, or three 
of croton chloral with the same frequency. For the 
paralyses we should give two granules of phosphoric 
acid or of phosphide of zinc three or four times daily. 
Hyperesthesia may be treated with local stimulant ap- 
plications and the internal use of two granules of cicu- 
tine every hour until relief is obtained ; for anaesthesia 
we should give five granules of nitrate of pilocarpine 
three to four times daily, combining with it three gran- 
ules of valerianate of zinc three times daily. 

"^ /Dominant \ Want °f nervous equi- ( Aconitine, digitaline, hyoscya- 
2 ' ' t librium . . 1 mine, arseniate of strychnine. 



PS 
H 
pH Wariakt 



Contractures 
Paralyses 
\ Hyperesthesia 
Anaesthesia . 






Hyoscyamine, salts of atropine. 
( Phosphoric acid, phosphide of 
( zinc. 

Cicutine, croton chloral. 

Nitrate of pilocarpine, valerian- 
ate of zinc. 



Icterus. — Icterus is a symptom which is common 
to different morbid conditions, but must be studied by 
itself, for it requires particular treatment not only when 
it is a feature of a disease which has been correctly 



ELEMENTS OF DOSIMETRIC PRACTICE. 341 

diagnosticated, but also when it belongs to diseases 
which have not been recognized, or concerning the di- 
agnosis of which there is doubt. It may be due to the 
retention of bile in the biliary ducts, or it may occur 
when there is no retention of bile. Retention is due to 
different causes — obstruction, inflammation, spasm, ex- 
ternal pressure. Obstruction is almost always caused 
by biliary calculi, which prevent the passage of the bile 
into the intestine. Its treatment consists principally 
in the use of cholagogues, or podophyllin in five- gran- 
ule doses once or twice daily, and suitable mineral 
waters. Inflammation diminishes the caliber of the 
canals, and also gives rise to obstruction on account of 
the resulting exudate, thus causing catarrhal icterus. 
As this inflammation is almost always due to the ex- 
tension of a gastro- duodenitis, the protopathic lesions 
must be carefully treated. A milk-diet and two gran- 
ules of cotoine every two hours will fill this indication. 
Catarrhal icterus itself should be treated with two gran- 
ules of calomel and two of arseniate of soda every two 
hours. Icterus may also result in consequence of the 
retention of bile on account of spasm, this variety being 
known as nervous icterus. A granule of hyoscyamine 
every three hours and saline laxatives (Sedlitz Chan- 
teaud) will quickly restore the flow of the bile. Reten- 
tion may also be caused by the pressure which may be 
exercised by tumors of different kinds upon the ex- 
cretory canals. The removal of the cause, and the use 
of strychnine to aid the fibro-muscular coat in over- 
coming the obstacle, constitute the most rational treat- 
ment. Icterus which is manifested when there is no 
retention of bile (the fseces giving evidence of biliary 
influence, while in cases of retention they are white 
and clay-like) may be due to polycholia — that is, ex- 
aggeration of the bile- secreting function — so that the 
canals can not entirely evacuate themselves into the 
intestine, whence resorption follows just as in cases of 
retention ; or it may be due to toxaemia, either because 



342 ELEMENTS OF THERAPEUTICS AND PRACTICE, 

the changed functions of the canals permit an abnormal 
resorption, or because the red globules are destroyed, 
their hsemaglobin being changed in the blood into 
bilirubin. In this latter class are included the grave 
forms of icterus which appear to be produced by in- 
fectious intoxication of a parasitic character. The 
analogy which this form presents, as to its symptoms 
and progress, with the symptoms and progress of many 
other infectious diseases, warrants this hypothesis. It 
would, therefore, seem reasonable that the salicylates, 
especially the salicylate of quinine, and possibly the 
sulphide of calcium as well, should be useful in these 
cases. As to the variant, the following indications are 
to be filled : Constipation should be treated with three 
to five granules of podophyllin twice daily, and in the 
morning a spoonful of Sedlitz Chanteaud. The dys- 
pepsia, which is due to a deficiency of bile, the latter 
causing unusually rapid decomposition of the contents 
of the intestine and imperfect elaboration of the food, 
may be modified by the use of three granules of quas- 
sine and three of elaterine before each meal. Pruritus, 
which accompanies icterus, and is sometimes almost 
unendurable, may be relieved either by taking two 
granules of croton chloral every quarter of au hour 
until relieved, or by acetic-acid baths, a quarter of a 
liter of acid being used to fourteen liters of warm 
water. The diminution in the number of pulse-beats 
which is produced by the action of the biliary acids, 
and the hypochondria which has such a depressing 
action upon the patients, may be treated with two to 
three granules of the arseniate of strychnine three times 
daily. Haemorrhages call for a combination of two 
granules each of arseniate of strychnine and ergotine 
every two hours. Chronic icterus has two particular 
indications which should not be overlooked. The first 
consists in inciting the contractility of the fibro-mus- 
cular tunic of the biliary passages to compensate the 
atony which results from dilatation of the canals in 



ELEMENTS OF DOSIMETRIC PRACTICE. 



343 



consequence of the accumulation of bile. The second is 
the necessity for destroying the bilirubin which is in the 
blood by pulmonary oxygenation. For the atony two 
granules of strychnine four or five times daily may be 
given ; for the failure of oxygenation, exercise, gym- 
nastics, inhalations of oxygen, or aerotherapy may be 
prescribed. 



Dominant. ( 



Variant. ( 



ICTERUS. 

Obstruction. 

( From retention j Inflammation 
of bile 

Spasm. 

Compression 

Without reten-( Pol > Tcholia ' 
tion of bile . "j Toxaemia 

( Infection . 

/Constipation . 

Dyspepsia 
Pruritus . 

Diminution of the pulse 
Hypochondria . 

Haemorrhages . 

^Retention of bilirubin 



j Cholagogues, benzoate of 
/ lithia. 

Cotoine, milk diet. 

Calomel, arseniate of soda. 
( Hyoscyamine, Sedlitz Chan- 
| teaud. 

Strychnine, 
j Podophyllin, Sedlitz Chan- 
( teaud. 

Arseniate of strychnine. 

Salicylate of quinine. 
{ Sedlitz Chanteaud, euony- 
1 mine, podophyllin. 

Quassine, elaterine. 

Croton chloral. 

Arseniate of strychnine. 

j Sulphate of strychnine, ergo- 
] tine. 
Exercise, diuretics. 



Incontinence of Urine. — This condition may come 
from such different causes that it should properly be 
considered as a symptom and not a distinct disease. 
Its frequency, however, compels all authors to make 
particular allusion to it, and to give it a particular place 
in their nosological classifications, and, in addition, to 
prescribe the treatment which is appropriate for it un- 
der different circumstances. Most of the cases which 
are met in practice belong rather to surgical than med- 
ical affections. Others, on the contrary, which are in- 
cluded under the term nocturnal incontinence, have 
nothing to do with surgery, and come entirely within 
the domain of medical therapeutics. This class of cases 
is especially referred to in this chapter, but advantage 
is also taken of this opportunity to observe that, in 
surgical cases, the surgeon should take pains to remedy 
the condition which affects the vitality of the diseased 



344: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

organs, if lie does not wish to replace the existing dis- 
ease with one which is more severe. Permanent cathe- 
ters, for example, are dangerous in these cases, for the 
urine becomes readily changed, and phosphatic salts 
are deposited around the catheter, which may become 
foci for the development of calculi, while the urethral 
and vesical mucous membranes may also be inflamed 
by the prolonged contact with them of a foreign body, 
and complications which are more or less grave may 
result. The methodical evacuation of the bladder, in 
place of the natural evacuation, may be substituted in 
cases in which there is paralysis of the organ, for in this 
way overdistention of the organ, with consequent re- 
laxation of its muscular fibers, may be avoided. Strych- 
nine and ergotine are the drugs which should be used 
in treating this condition. In these cases, as in cases 
of paralysis of the sphincter, these two drugs may be 
depended upon, a cure being a question only of time 
and dosage. In many cases among the aged the author 
has seen the paralysis disappear when a return of ves- 
ical contractility could not be anticipated, and this 
from the use alone of these two drugs. Strychnine 
must be given in constantly increasing doses ; ergotine, 
on the other hand, must be given at intervals, in order 
to avoid a possible capillary gangrene. In nocturnal 
incontinence the use of strychnine will constitute the 
treatment of the dominant, because there can be no in- 
continence without a certain degree of relaxation of the 
sphincter. In many cases, however, it is not this re- 
laxation nor the atony of the sphincter which causes 
the unconscious discharge of the urine, for it may be 
due to a change in some of the vital elements which are 
concerned in the normal discharge of the urine, the 
physiological equilibrium being thus disturbed. 

The factors which are concerned in the emission of 
the urine are several, and include the chemical compo- 
sition of the urine and its quantity, the degree of irrita- 
bility of the mucous membrane, the nerves which trans- 



ELEMENTS OF DOSIMETRIC PRACTICE. 345 

mit impressions from the perix>hery, and the nerv- 
ous centers which transform them into sensation ; the 
brain, which perceives the sensation ; the will, which 
directs the contraction of the muscles ; the sphinc- 
ter, which opposes the passage of the urine ; and the 
muscular tunic of the bladder, which overcomes this 
resistance. If there is increase or diminution in any 
of these elements in the excretory act, the emission 
of urine will cease to be normal. Should the sphinc- 
ter offer less resistance than is normal, the urine will 
pass off involuntarily. Such cases may be readily 
cured by strychnine and by hydrotherapy, which will 
increase the resisting force of the sphincter. With 
children it is well to take the precaution to cause them 
to arise and evacuate the bladder in the middle of the 
night, so as to prevent too great an accumulation within 
it. If, on the other hand, the brain no longer recog- 
nizes the necessity of emptying the bladder, there are 
means which are very efficacious for remedying this 
defect. Atropine and caffeine, given at bedtime in 
gradually increasing doses, will accomplish excellent 
results, and this treatment should be continued until a 
cure is effected. In most cases two to three granules 
of atropine, and four to six of caffeine, given every 
evening in one dose, or in several should the patient 
be inclined to wakefulness, will be sufficient to effect a 
cure for this trouble, which, though it may not appear 
to be of great gravity, should be attended to, for it may 
lead to spermatorrhoea, and even to epilepsy. In other 
cases the brain is conscious of the necessity for evacua- 
tion of the bladder, but the child (if it be a child) can 
not exert sufficient will-power to overcome the muscu- 
lar inactivity which accompanies sleep. Corporal pun- 
ishment in such cases usually does little good. Vesi- 
cants applied over the sacral region are sometimes 
effective, but the use of caffeine is preferable, and the 
requirement that the child should completely empty 
his bladder as often as he is compelled to rise from his 



346 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

bed. In other cases the sensitiveness of the vesical 
mucous membrane is increased, either from the excess 
of irritant properties in the urine, as an excess of uric 
acid, or from irritation proceeding from neighboring 
organs — for example, the irritation caused by ascarides, 
indigestion, etc. In such cases small quantities of 
urine produce the same impression upon the bladder 
that is produced by large quantities in the normal con- 
dition, and, as a result, the sensibility of the brain is 
blunted by the frequent repetition of the same impres- 
sion. Three to six granules of cicutine and of bromide 
of camphor may be given daily, five to eight of santo- 
nine and of calomel twice daily, six of the benzoate of 
soda and of asparagine daily, and, if the conditions in- 
dicate, two granules of pepsin and of iron with each 
meal, and Sedlitz Chanteaud in sufficient quantity. 

INCONTINENCE OF URINE. 



1st. From the Forced Opening of the Sphincter and the Urinary Passages 
(Incontinence from Regurgitation). 

( Methodical evacuation of the 
Paralysis of the bladder . . . < bladder by surgical means, 

( strychnine. 

Hypertrophy of the prostate . . j M ^^ evacuation > er S otine ' 

Obstacles in the urethra . . . Surgical intervention. 

2d. From Permanent Opening of the Sphincter (True Incontinence). 
Paralysis of the sphincter . . . j ffi^ of strychnin* 
Organic lesions of the prostate . . Do /; sal decubi t us > treatment of 
Foreign bodies Treatment of the cause. 

3d. From Intermittent Opening of the Sphincter (Essential, Nocturnal, 
or Infantile Incontinence). 

Atony of the sphincter . . . | ^^^^^^' 

C-bral torpor I^Sr 

Torpor of the will .... | Mo^and preventive means. 

( Fr a°c?d 6XCeSS ° f UrIC [ Benzoat ' e of lithia ' 
Increase in the Ascarides m th ' e rec I > 

i Y»rn rnhlhtTT r\T ( 



irritability of ( ^ J- Santonine, calomel, 

the bladder changes in digestive j Lactate of iron, pepsin. 
\ power . . . ( Sedlitz, etc. 



ELEMENTS OF DOSIMETRIC PRACTICE. 347 

Indigestion,, — Difficulties in the digestion of in- 
gested food may arise from excess as to their quantity, 
from the accidental absence of the gastric juice, or from 
suspension of the peristaltic motion of the stomach. 
When the quantity of food or of drink has been too 
great, the two other conditions of apepsia mentioned 
may be realized ; for, on the one hand, the usual quantity 
of the gastric juice will not suffice to effect chymification 
of the unusual quantity of food, and, on the other, 
mechanical dilatation of the stomach will weaken the 
energy of its contractility and produce temporary pa- 
ralysis. The means to be employed in the different 
conditions will differ in accordance with the cases. If 
indigestion is due to an excess of peptonizable food, 
three granules of pepsin may be given every half -hour. 
If the excess consists of starchy foods we should give 
the same quantity of diastase. Gastric atony, which 
always accompanies this form, should be treated with 
two grannies of quassine every quarter of an hour. If 
indigestion is caused by excitement of the reproductive 
apparatus, by violent disturbance of any kind, etc., a 
granule of sulphate of strychnine should be given every 
quarter of an hour, and nourishing food in small 
quantities. For the intense headache which sometimes 
accompanies indigestion, a granule of caffeine should be 
given every half -hour. If the circulation of the brain 
seems to be affected, apomorphine should be adminis- 
tered hypodermically, to excite vomiting, if this result 
has not been obtained by other means, such as putting 
the finger down the throat, tickling the palate, etc. 
After the attack has been brought under control, we 
should give Sedlitz Chanteaud to relieve the digest- 
ive canal of any undigested food which may remain, 
and to overcome the saburral condition which follows 
these disorders of digestion; two granules of quas- 
sine should also be given before each meal to restore 
to the stomach the energy which was suspended by its 
overwork. 



348 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

rh r -n™™ » „m \ Gastric atony Quassine. 

™. r Dominant, j Apepsia * ^^ ^^ 

2o J I Cephalalgia Caffeine. 

O |n L Variant, -j Apoplectiform condition . . Emetics. 

£} ( Saburral tongue .... Sedlitz Chanteaud. 



Infection, Paludal. — There is no doubt but that 
miasmatic intoxication results from the presence in the 
organism of a poison which is produced in marshy and 
other places where decomposition of vegetable matter 
is freely taking place. The toxic agent must be a liv- 
ing organism, for the regularity in the periodicity of 
the attacks can on]y be explained by considering such 
a cause. The dynamic perturbations whicji this agent 
produces are related to the vaso-motor system, as is 
evidenced by the contraction in the peripheral vessels 
and the congestion of the spleen. As a causal domi- 
nant, quinine should be given to antagonize the infec- 
tion, for experience has shown that it is the most 
prompt in its action, and the most efficient of all the 
agents which have been proposed for malarial or 
paludal poisoning. As a vital dominant, we should 
give strychnine, the excito-motor properties of which 
are sufficiently known. Large doses of quinine are, 
as a rule, useless and even dangerous. Three to six 
granules of the hydroferrocyanate of quinine every 
hour, combined with one of the arseniate of quinine, will 
usually be sufficient to rapidly control the periodicity 
of the attacks. The hydroferrocyanate may be re- 
placed by some other salt of quinine if the indications 
warrant it. In the neuralgias of malarial origin the 
hydrobromate will be preferable, in spasmodic condi- 
tions the valerianate, and in rheumatic conditions the 
salicylate, the dose of each being three to five granules 
daily. If we seek to apply a still more active means of 
treatment without increasing the doses of quinine, six 
to eight granules of arsenious acid daily may be added. 
If the digestive organs are in bad condition, the tongue 
being heavily coated, constipation being present, etc., 
the treatment should be commenced with an emetic, 



ELEMENTS OF DOSIMETRIC PRACTICE. 349 

for otherwise we could have no assurance that the 
medicaments would be absorbed. For this purpose 
three granules of emetic may be given to an adult every 
ten minutes ; to a child, emetine in similar quantities, 
being careful to dissolve the drug in a little water be- 
fore administering it, that the effect may be more 
prompt. If the gastric disturbance is not decided, a 
large spoonful of Sedlitz Chanteaud dissolved in sugar- 
water or in a bitter infusion may be all that will be re- 
quired. During the chill we should give one-granule 
doses of phosphoric acid or hypophosphite of strych- 
nine every half -hour until reaction occurs ; the 
shorter this stage, the less intense will the disease 
be, and the easier its cure. During the febrile 
stage we should use a granule of aconitine every half- 
hour, and continue it until sweating commences. 
In the sweating stage we should return to the strych- 
nine, and begin the antiperiodic treatment with quinine 
and arsenious acid. The headache, which is sometimes 
intense and may be aggravated by large doses of qui- 
nine, which also causes insomnia with consequent 
fatigue and weakness of the patient, should be treated 
with two granules of arseniate of caffeine every hour. 
If there is anorexia even during the apyretic period, 
three granules of quassine should be given before each 
meal. The appetite must not be neglected even in 
cases in which the appearance of the tongue contra-indi- 
cates the use of solid food. The repetition of the 
febrile attacks, and the destruction of the red corpuscles 
by the paludal poison, will quickly cause a condition of 
anaemia for which one should give one to ten granules of 
arseniate of iron daily. If haemorrhages occur, we 
should administer three granules of ergotine and three 
of sulphate of quinine every quarter of an hour. 
In that variety of malarial poisoning which yields the 
so-called pernicious fever, quinine is still the sovereign 
remedy, but as time is precious in such cases, and as 
we can not always be certain of gastro-intestinal absorp- 



350 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



tion during the attack, the lactate or hydrobromate of 
quinine must be given hypodermically. Remittent 
fever requires the same treament as intermittent, but 
it is less urgent in character because the progress of the 
disease is slower. In this condition we may use a 
granule of strychnine every two hours daily, and, in 
the course of a day, thirty or forty granules of the 
hydroferrocyanate, the sulphate, or the salicylate of 
quinine in addition. Masked or larval fevers, when 
their true nature is recognized, are treated in the same 
way as the regular forms. It must not be forgotten 
that periodicity in the attacks, which most frequently 
occur between midnight and midday, is the character- 
istic which will lead us to a knowledge of the true 
character of the disease. A successful result of the use 
of antiperiodic agents will remove any doubts as to the 
diagnosis which may have existed. 





'Dominant. • 


i Paludal miasm 

1 Vaso-motor paralysis 


Quinine, arsenious acid. 
Strychnine. 




Arseniate of strychnine. 




Headache 


Arseniate of caffeine. 


^H 




Anorexia 


Quassine. 




\ Variant. ( Gastric disorder . 


\ Sedlitz Chanteaud, emetic. 
( Emetine. 






Hyperthermia 


Aconitine. 






Anaemia 


Arseniate of iron. 






\ Haemorrhage 


Ergotine, sulphate of quinine 



Infection, Purulent. — See Traumatic Fever. 

Laryngitis, Acute Catarrhal {Stridulous Laryn- 
gitis, Pseudo- Croup). — Acute inflammation of the 
larynx, whether due to internal or external causes, 
should be treated with aconitine, which is not only the 
antiphlogistic agent par excellence, but has the addi- 
tional merit of almost always satisfying the causal in- 
dication, because the greater number of cases of acute 
laryngitis are due to suppression of the perspiration, 
which is restored by the use of only a few granules of 
aconitine. This drug should, therefore, have the pref- 
erence in all acute cases, one granule being given every 
half -hour until a sedative or diaphoretic effect is ob- 



ELEMENTS OF DOSIMETRIC PRACTICE. 351 

tained. Subacute laryngitis, in which the pain is slight 
and the fever moderate, does not require such active 
treatment ; one granule every two hours will suffice. 
The fever of this condition will also yield to the influ- 
ence of aconitine, which should be administered until 
defervescence has occurred. After the fever has abated, 
the symptoms may be treated in succession. Cough 
and hoarseness should be treated with one granule of 
one of the active principles of opium and one of iodo- 
form every quarter of an hour until relief has been ob- 
tained. Codeine should be preferred to the other active 
principles of opium if a child is being treated, Greg- 
ory's salt if the cough is of moderate intensity in an 
adult, and the hydriodate of morphine if the cough is 
continuous and fatiguing. Iodoform, which is useful 
for hoarseness, is in many cases offensive to sensitive 
patients. In such cases two-granule doses of benzoic 
acid every hour should be substituted. The granules 
should be dissolved in the saliva before being swal- 
lowed, in order to get the benefit of their local action. 
The collections of mucus which adhere to the vocal 
cords are sometimes the cause of suffocation, especially 
in children, on account of the mechanical obstruction 
to the entrance of air which they offer. Even in the 
severest cases we may administer emetine in three- 
granule doses, dissolved in warm water, giving it every 
ten minutes until the patient vomits. By this means 
the exudation will be dislodged, and facility of respira- 
tion will be restored. If the case is not urgent, instead 
of exciting vomiting, we should trust to the slower but 
equally effective action of sulphide of calcium, which 
may be given in two-granule doses every hour to aid in 
breaking up the accumulations of mucus, and hasten 
the resolution of the inflammation. The presence of 
an exudate, or excessive irritability of the larynx, will 
produce, especially in children, a kind of dyspnoea, 
which is caused by spasm of the glottis. This condi- 
tion bears the name of stridulous laryngitis, or pseudo- 



352 ELEMENTS OF THERAPEUTICS AFD PRACTICE. 

croup. A granule of hyoscyamine every hoar, or half 
a granule for children under six years of age, or two 
granules of the sulphide of calcium every half-hour, 
will promptly relieve this condition, which is always 
painful, and sometimes is dangerous. The headache 
which occurs in the first days of the disease may be 
relieved by the use of two granules of caffeine every 
hour, or three of the bromide of camphor every hour. 
Pain in the larynx will not necessarily require treat- 
ment, especially if the patient is wise enough to abstain 
from talking ; should medication be required, however, 
three granules of codeine may be given every half-hour 
until an anodyne effect is obtained. Spasmodic laryn- 
gitis is sometimes repeated in a manner which plainly 
shows its intermittent character. This periodicity may 
be controlled by the use of three granules of the hydro- 
bromate of quinine and one of hyoscyamine every three 
hours. With laryngeal inflammations the more fre- 
quent their recurrence the greater the susceptibility to 
additional attacks. In order to overcome this suscepti- 
bility to impressions of cold, two granules of arseniate 
of strychnine and two of sulphide of calcium should be 
given three times daily for a long time. Hydrotherapy 
and light clothing, by fortifying the skin against ex- 
ternal impressions, are excellent adjuvants to internal 
treatment of a preventive character. 

cq / Dominant. Inflammatory element Aconitine. 



^^ I Variant. 



/Cough 
Hoarseness . 
Mechanical dyspnoea 
Spasmodic dyspnoea 
Headache 
Fever . 
Pain 
Intermittence 



Codeine, Gregory's salt. 

Iodoform, benzoic acid. 

Emetine, sulphide of calcium. 

Hyoscyamine. 

Caffeine. 

Aconitine. 

Codeine. 

Hydrobromate of quinine. 



Catarrhal P-disposition j ™£^* 

Laryngitis, Chronic. — Chronic inflammation of 
the larynx may be simple or constitutional, and may 
or may not be accompanied with ulceration. The ul- 
ceration is the consequence of the long duration of the 



ELEMENTS OF DOSIMETRIC PRACTICE. 353 

disease, and should be treated topically in addition to 
the internal treatment which is directed toward its 
cause. The local treatment may consist in the use of a 
spray containing equal parts of sulphur- water and tar- 
water. The internal treatment includes both the domi- 
nant and the variant, the former being the most impor- 
tant and the most efficacious. If the laryngitis is purely 
of a catarrhal character, we may give two granules of 
sulphide of calcium and two of helenine three to five 
times daily. Revulsives, hydrotherapy, and a suitable 
change of climate will also be of great service. Laryn- 
gitis which depends upon a general disease should be 
treated in accordance with the nature of the primary 
complaint. Syphilitic laryngitis of the first period 
should be treated with two to five granules of the pro- 
tiodide of mercury three times daily, or with two to 
three granules of the biniodide three times daily. 
Syphilitic laryngitis of the secondary period should be 
treated with three to five granules of iodoform three 
times daily, while upon the ulcerations Yan Swieten's 
solution should be applied. Laryngitis of the tertiary 
period is almost always caused by suppurating gum- 
mata, and should be treated with two to three granules 
of iodoform and the same quantity of arseniate of soda 
three times daily. Laryngeal tuberculosis and laryn- 
gitis in tuberculous subjects may also be modified by 
the use of iodoform, three granules being given every 
three hours, with two of the arseniate of soda or of iron 
three or four times daily. Laryngitis which is the re- 
sult of variolous pustules may be treated with repeated 
doses of sulphide of calcium, one to three granules 
being given every half -hour ; this drug also tends to 
attenuate the infectious element of the disease. Laryn- 
gitis which accompanies typhoid fever and typlius ex- 
anthematicus should be similarly treated, two granules 
of the salicylate of ammonia every hour being added. 
The dysphonia of the disease will rarely require par- 
ticular treatment. Two granules of tannic acid four 

23 



354 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



times daily will modify the vitality of the larynx, and 
will prove very useful by its local astringent action. 
The cough and pain, which may be very troublesome 
to the patient, may be relieved by the use of two gran- 
ules of the hydrobromate of morphine every quarter of 
an hour until relief is obtained. Dyspnoea may result 
from several causes, of which stenosis of the larynx is 
the principal one, and this may be due to particular 
lesions or to the accumulation of exudate. Emetine in 
doses of three to five granules every ten minutes until 
vomiting results, followed by two granules of the sul- 
phate of strychnine every hour, constitute the best 
means for relieving the dyspnoea. Should suppuration 
follow the chondritis and perichondritis, two granules 
each of iodoform and arseniate of soda may be given 
three or four times daily. The foregoing suggestions 
as to treatment should be followed out for a long 
time, and accompanied with suitable hygienic pre- 
cautions. 



8^ 
&& 

Hi 



►h / Dominant. 



Variant. 



Catarrhal element 

f Syphilitic . 

Infectious J Tuberculous 
element I Variolous . 
[ Typhous . 

Dysphonia . 

Cough .... 

Pain .... 

Dyspnoea 
i Suppuration. 



Helenine, sulphide of calcium. 
Iodoform, mercury. 
Iodoform, arseniate of soda. 
Sulphide of calcium. 
Salicylate of ammonia. 
Tannic acid. 

>■ Hydrobromate of morphine. 

Emetine, sulphate of strych- 
nine. 
Iodoform, arseniate of soda. 



Laryngitis, Stridulous. — See Acute Catarrhal 
Laryngitis. 

Leucocythsemia. — Leucocythsemia implies a con- 
dition in which the number of the white blood-globules 
is greatly increased and the red globules greatly di- 
minished. This permanent excess and disproportion of 
the leucocytes are due to functional and nutritive irri- 
tation of the haematopoietic organs, and require the 
administration of two granules of hydrobromate of 
cicutine and of iodoform five times daily. The physic- 
al and moral prostration which is experienced by suf- 



ELEMENTS OF DOSIMETRIC PRACTICE. 355 

ferers with this disease should be met by the adminis- 
tration of two granules of the arseniate of strychnine 
three to five times daily. The anorexia, which tends 
greatly to aggravate the disease, will be relieved by 
giving two to four granules of quassine a short time 
before each meal. For the constipation, three to five 
granules of podophyllin should be given each evening. 
Should diarrhoea occur, and this is not unusual, espe- 
cially when the chyliferous ducts are attacked, three 
granules of pepsin should be given with each meal to 
facilitate digestion, and two granules of the hydriodate 
of morphine every two hours, that the food may be de- 
tained in the alimentary canal a sufficient time to insure 
absorption. For the accompanying ulcerative stomati- 
tis, we should use suitable mouth- washes and two gran- 
ules of the lactate of iron every two hours. Dyspnoea, 
which results from the absence of a vehicle for the oxy- 
gen which is inspired by reason of the diminution of 
the red globules, and frequently on account of the 
swelling of the bronchial glands, should be treated 
with inhalations of oxygen, which is the only means by 
which the patient can be rapidly relieved. Swelling of 
the spleen, the liver, and the glands should be treated 
by the dominant, to which three granules of ergotine 
three to five times daily may be added. The results 
which are produced by quinine in analogous conditions 
may induce us to try it in this, and three granules of 
the hydrobromate may be used every two hours. Fever 
is almost always present toward the end of the disease, 
for which one granule of quinine is indicated every two 
hours or less, according to the degree of hyperthermia. 
For haemorrhage, which sometimes occurs, we should 
give three granules of ergotine every two hours, adding 
in appropriate cases two granules of the phosphate or 
valerianate of iron every two hours. Hydrotherapy, 
exercise, and change of air are hygienic means which 
must not be overlooked in the treatment of this dys- 
crasia. 



356 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



d /Dominant. 



^Variant. ( 



Irritation of the hsemato 
poietic organs 
/ Prostration 
Anorexia . 
Constipation . 
Diarrhoea . 
Ulcerative stomatitis 
Dyspnoea . 
Glandular swellings 
Fever 
Haemorrhage . 



Hydrobromate of cicutine, 

iodoform. 
Arseniate of strychnine. 
Quassine. 
Podophyllin. 
Hydriodate of morphine. 
Lactate of iron. 
Inhalation of oxygen. 
Ergotine. 
Aconitine. 
Ergotine. 



Leucorrhoea. 



common to vaginitis and to chronic metritis. 



Leucorrhoea is a symptom which is 

In the 

first case, the vaginal hypersecretion has little effect 
upon the general condition, and is scarcely to be con- 
sidered as a disorder ; in the second, it is accompanied 
by rapid loss of strength, capricious appetite, nervous 
troubles, both of sensibility and motility, and is a true 
morbid condition, which requires for its cure a rational, 
energetic, and persevering plan of treatment. Examina- 
tion with the speculum should always precede a course 
of treatment, and frequently one will find ulcerations, 
granulations, foreign bodies, etc., which must be suit- 
ably treated before general treatment is instituted. The 
difficulties which are encountered in manipulations of 
this kind furnish a motive for the careful examination 
of the physical properties of the white material which 
is discharged as the first step in therapeutic action. 
Leucorrhoea, which continues or increases with the ap- 
proach of the menstrual period, demonstrates that con- 
gestion is the primary morbid process ; whether this 
congestion is active or passive can not be said, because 
the characteristic signs are wanting. Apparently the 
condition is one of atonic hyperemia, or of lymphatic 
congestion, rather than a true afflux of blood to the 
vaginal mucous membrane. The excito-motor action 
of ergotine upon the genital organs indicates it as the 
dominant in this condition, and with it strychnine may 
be associated. Two granules of each, either separate- 
ly or combined, may be given four times daily. For 
topical applications any of the astringents may be used, 



ELEMENTS OF DOSIMETRIC PRACTICE. 357 

though tannin is to be perferred. A mixture of three 
grammes of tannin and thirty of glycerin may be used 
to saturate pledgets of cotton wool, and the latter be 
introduced in sufficient quantity into the vagina and 
retained for twenty -four hours. Yaginal injections 
with a solution of borated chloral are also useful, espe- 
cially if the discharge is offensive. Anaemia and chlo- 
rosis, whether acting as cause or effect of this condition, 
should be treated with arseniate of iron and other ap- 
propriate means. (See Ansemia.) The debility which 
always accompanies this condition, to a greater or less 
degree, should be treated with one granule of the ar- 
seniate of strychnine four times daily. Irritability, 
melancholy, and other neuropathic conditions which 
are seen in connection with leucorrhcea, will disappear 
under the use of three granules of bromide of camphor 
three to four times daily. Palpitations, which are 
almost always caused by dex>ression of a moral char- 
acter, indicate the use of two granules of caffeine four 
times daily, or three of valerianate of caffeine four 
times daily. For gastralgia two granules of valerianate 
of zinc should be given three times daily, or two of the 
cyanide of zinc before each meal. Constipation, which 
is so common in all conditions in which there is loss of 
nervous equilibrium, should be treated with two gran- 
ules each of hyoscyamine and veratrine morning and 
evening. Quassine may be given to regulate the appe- 
tite, which is often capricious. Leucorrhcea of long 
duration is sometimes complicated with prolapses of 
the vagina, and may be relieved by the use of ergotine 
and strychnine, as already indicated, together with ap- 
propriate local means for overcoming muscular relaxa- 
tion. A condition of herpes often contributes to the 
persistence of chronic vaginitis, and should be treated 
with two granules of sulphide of calcium five times 
daily. The lymphatic diathesis should be treated with 
iodoform combined with the arseniates. Yisible results 
may be expected after a few weeks of treatment with 



358 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



two granules of iodoform, two of arseniate of iron, and 
three of ergotine daily. But, if this plan of treatment 
does not result in diminution of the discharge, it will 
be almost useless to resort to any other, for the result 
will be equally negative. In rebellious cases it may be 
well to try the effect of injections of nitrate of silver, 
in the hope of modifying the condition of the mucous 
membrane. This plan should only be resorted to in 
exceptional cases, for great inconveniences are associ- 
ated with it, and its efficiency is more than doubtful. 



\ Variant. ( 



Dominant. Atonic hyperemia 
/Anaemia 
Debility 
Irritability . 
Palpitations . 

Gastralgia . 

Constipation . 
Irregular appetite 
Prolapse of the vagina 
Herpetic diathesis 
Lymphatic diathesis 



Ergotine, strychnine. 

Arseniate of iron. 

Arseniate of strychnine. 

Bromide of camphor. 

Caffeine, 
j Valerianate of zinc. 
\ Cyanide of zinc. 

Hyoscyamine, veratrine. 

Quassine. 

Ergotine. 

Sulphide of calcium. 

Iodoform, arseniates. 



Lithiasis, Biliary.— Biliary lithiasis results from 
the precipitation of some of the elements of the bile, 
calculi being formed, which will vary in size from the 
head of a pin to a hen's egg. The cause of this pre- 
cipitation may be a relative disproportion in the dif- 
ferent elements of the bile or the presence of mucus 
in the bile-ducts, the mucus serving as centers around 
which concretions are formed in a manner analogous 
to the formation of thrombi in the vascular system. 
All the conditions which concur in increasing the quan- 
tity of cholesterin (e. g., expenditure of nerve-force), 
in producing biliary stasis (e. g. , insufficiency of food), 
in causing hyperemia of the liver (e. g., a sedentary 
life), as well as the modifications of the secretions 
which are included under the general term of arthritic 
diathesis, are predisposing causes which must be taken 
into consideration in arranging a plan of treatment. 
The principal indications which must be considered in 
the treatment of this disease may be reduced to two : 



ELEMENTS OF DOSIMETRIC PRACTICE. 359 

1. To facilitate the removal of calculi which are 
already formed. 

2. To prevent the formation of new calculi. 

To satisfy the first indication, we have two classes 
of agents, one of which is used to diminish the volume 
of the concretions, and the other to enlarge the caliber 
of the canals which are to be traversed. Science does 
not yet possess unfailing means for dissolving biliary 
calculi, except as they are to be found in the sodium 
waters of Vichy, Carlsbad, and Gerez. These waters 
have an incontestable efficiency, which is proved by 
the number of cases in which calculi have been elimi- 
nated after their use ; and this must be taken as a 
proof that their elimination has been facilitated by a 
diminution in their size. As a substitute for these 
waters, we may prescribe the salts of lithia, six to ten 
granules of the benzoate being given daily, or four to 
six granules of the carbonate, the benzoate being pre- 
ferred, because it is both cholagogue in its action and 
lithontriptic. The biliary canals are furnished with a 
fibro-muscular tunic, are therefore contractile, and are, 
in addition, abundantly supplied with sensory nerve- 
filaments. If the calculi are subjected to the slightest 
arrest in their passage, spasm and violent pain in the 
liver are the result, which render their elimination still 
more difficult. The spasm should be treated with hy- 
oscy amine or its congeners, valerianate of atropine and 
daturine, one granule being given every quarter of an 
hour when the hepatic colic is intense, or two granules 
twice daily if the pains are less severe, but of frequent 
occurrence. The pain which is due to the spasm, and 
also serves to intensify it, should be treated with three 
granules of the hydrochlorate or the hydrobromate of 
morphine every quarter of an hour. The morphine 
will also serve to check the vomiting, which is another 
symptom ; but, should the stomach be so sensitive 
that the medicaments are rejected before there is any 
opportunity for their absorption, morphine combined 



360 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

with atropine should be injected subcutaneously in 
doses of fifteen or twenty drops of the following : 

^ Morphinge hydrochl 0*10 gramme. 

Atropine sulph 0*01 " 

Aquae destil 20*00 grammes. 

The pain may be so severe as to cause lipothymia or 
syncope. In such ca,ses, no uncertain remedies are al- 
lowable ; and hence, if lipothymia is present, the evi- 
dence of musculo-nervous atony, a granule of hyoscya- 
mine and one of arseniate of strychnine should be given 
every half-hour to restore the equilibrium, and allow 
the calculi to proceed on their way without affecting 
the vitality of the fibro-muscular tunic. Gastralgia 
should be treated in precisely the same way as hepatic 
colic, the cause being the same. It frequently happens 
with patients who are the subjects of biliary lithiasis 
that there are attacks of intermittent fever which occur 
regularly at four or five o'clock in the afternoon. They 
are caused by the irritation of the calculi, which is ag- 
gravated by the hepatic hypersemia which accompanies 
the labor of digestion. For this complication we should 
use two granules of aconitine three times daily and two 
of arseniate of quinine every hour. To prevent the 
formation of new calculi we should use the same means 
as are used for their solution ; but, above all things, we 
should carry out the hygienic indications which are 
made manifest by a study of the predisposing causes. 
Influenced by such an investigation, we would be like- 
ly to advise very active exercise, vegetable diet, the 
daily use of Sedlitz Chanteaud, of sulphate of soda, or 
of purgative mineral waters which contain this salt — 
for example, Pullna, Hunyadi Janos, etc. — tranquilli- 
ty of mind, and such intellectual labor as shall not 
cause fatigue. The daily use of the cholagogues in 
small quantities, which shall not irritate the gastroin- 
testinal canal, is proper. Three granules of podophyl- 
lin may be taken every evening, ten of euonymine 
before dinner, five to eight of iridine, or ten to twenty 



ELEMENTS OF DOSIMETRIC PRACTICE. 361 

of hydrastine or leptandrine in two equal doses daily. 
All of these drugs excite evacuation of the bile without 
increasing the number of the biliary salts. They may 
therefore be used for a long time without fear of pro- 
ducing harmful irritation, if care is taken to change 
them from time to time. Quassine also excites the se- 
cretion of the bile, though to a lesser degree ; it has the 
additional advantages of increasing the appetite and 
regulating the digestion, which are not to be despised 
in the case of patients who are afflicted with this dis- 
ease, and are often in a condition of absolute cachexia. 



K*^ 


/ Dominant. 


Biliary concretions . 


j Benzoate of lithia. 

( Alkaline mineral waters. 


%< 




/Spasm 


Hyoscyamine. 


<7$ 




Pain. 


Hydrobromate of morphine. 






/ Vomiting . 


Morphine, atropine. 


ffl^ 


\ Variant. 


\ Febrile attacks. 


Aconitine, arseniate of quinine. 


1-3 






( Podophyllin, euonymine, iri- 






\ Biliary stasis . 


•< dine, hydrastine, leptandrine, 
( quassine. 



Lithiasis, Renal. — The treatment of renal lithiasis 
follows the same rules as that of biliary lithiasis. The 
difference in the cause and the chemical composition of 
the calculi, however, requires certain modifications of 
those rules. Renal lithiasis may be divided into acid 
and alkaline varieties, the first being of uric- or oxalic- 
acid origin, the second of calcareous or ammoniacal. 
The treatment should have for its object, first, the ex- 
pulsion of the calculi which have formed ; second, the 
antagonism of the causes which produce the calculi, 
that no more may be produced. In order to expel cal- 
culi from the kidneys, we should use diuretics as phys- 
ical agents, solvents as chemical agents, and mydriatic 
antispasmodics as dynamic agents. Diuretics are prop- 
er in all cases ; but they must be used only at proper 
intervals, and always with moderation, so as not to 
fatigue or irritate the organ. The diuretic which is 
most certain in its action, the most decidedly physio- 
logical, and the best tolerated, is good drinking water. 
By its action in increasing diuresis it may be hoped 



362 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

not only that the nriniferous tubes will be dilated, but 
also that the calculi will be expelled by pressure, and 
that the lubricating action of the water will facilitate 
their progress. The chemical means for dissolving cal- 
culi are of little importance. With the exception of 
lithia and the alkaline mineral waters, little benefit can 
be expected from the so-called lithontriptics. The al- 
kalies should be given dosimetrically — that is, in small 
and frequently repeated doses. The action of alkaline 
waters taken in this way and at the springs where they 
are produced is certainly excellent, and almost always 
causes the ready expulsion of calculi of larger or small- 
er size. Lithia may be given, under the form of gran- 
ules of the benzoate or the carbonate, in three-granule 
doses, three or four times daily. Large doses are use- 
less, for they do not find in the economy sufficient 
quantities of free carbonic acid to dissolve them. These 
agents are of particular usefulness in the uric-acid lithi- 
asis, but also in the oxalic-acid form. The suppression 
of the causes, which is always necessary in any rational 
plan of treatment, is absolutely indispensable in this 
condition ; for, since oxaluria is the evidence of a di- 
athesis which is caused by the use of certain articles of 
food which contain the abnormal elements in large 
quantities — such articles, for example, as sorrel and 
onions — all that will be necessary to cause the disap- 
pearance of the diathesis will be that the patient ab- 
stain from these articles of food. The alkaline varieties 
of lithiasis should receive treatment with three granules 
of salicylic acid three times daily, or similar quantities 
of salicylate of lithia. Benzoic acid may also be used 
with advantage in three-granule doses three or four 
times daily. The object of the dynamic means of treat- 
ment is to dilate the canals in which the calculi are en- 
gaged, and thus facilitate the progress toward the blad- 
der. Such means may consist of hyoscyamine in two- 
granule doses two or three times daily, or sulphate of 
atropine in one- to two-granule doses three times daily. 



ELEMENTS OF DOSIMETRIC PRACTICE. 363 

The arthritic diathesis predisposes to the formation of 
calculi. For those who are so affected we should pre- 
scribe plenty of exercise, sobriety at the table, modera- 
tion with respect to the sexual appetite, and the use of 
two to three granules of colchicine every evening. In 
the variant we meet with conditions of such importance 
that the patient not only demands relief from them in 
certain cases, but regards them as the most severe, most 
painful, most intolerable, and most rebellious of his 
troubles. Of the conditions referred to, colic is the one 
which is of most frequent occurrence as well as the 
most painful. It is the result of the sensitiveness and 
contractility of the ureters, and it is due to these char- 
acteristics that small calculi, which may be rough and 
uneven, cause much more intense pain than larger ones, 
which are smooth and more or less polished. For the 
pain we should give three granules of the hydrobromate 
of morphine every quarter of an hour, and for the 
spasm one of hyoscyamine every half-hour. The vom- 
iting which almost always accompanies the colic will 
also be benefited by this treatment. Rarely will it be 
necessary to use these alkaloids hypodermically. The 
vesical and rectal tenesmus will diminish as the hyos- 
cyamine is the more efficient in its action. The hyos- 
cyamine may be replaced by daturine, one granule being 
given every hour until the desired effect is obtained. 
Lipothymia, which may be converted into fatal syn- 
cope if the colic is of an intense character, should be 
treated with two granules of the arseniate of strychnine 
every quarter of an hour, and a free but judicious use 
of sedatives, especially of morphine. Convulsions, 
which may also be the result of intense suffering, must 
be treated with anodynes, to which three-granule doses 
of the bromide of camphor every ten minutes may be 
added. Hematuria in these cases will yield to three- 
granule doses of ergo tine every half -hour, or the same 
drug may be injected hypodermically. Inflammatory 
symptoms, of which the most common are those which 



364 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



are indicative of pyelitis, may be treated with one- 
granule doses of aconitine every two hours, the dose 
being increased if the case requires it. Dysuria or 
anuria will require the use of diuretics. Simple water 
with two granules of arbutine every two hours will fa- 
cilitate the excretion of urine. Hydronephrosis is the 
result of distention of the kidney in consequence of the 
retention of urine ; it can only be remedied by surgical 
means. 

( Uric-acid calculi 



/ Acid ) 

lithiasis 1 
1 Dominant. / 



Alkaline 
lithiasis 



Oxalic-acid calculi . 
Calcareous calculi . 
Ammoniacal calculi 



\ Variant. ( 



' Spasm 

Pain .... 

Nausea and vomiting 
Vesical tenesmus 

Convulsions 

Lipothymia 
Haematuria 

Pyelitis . 

Dysuria 

Hydronephrosis 



Carbonate and benzoate 
of lithia, alkalies. 

Diuretics, removal of 
the causes. 
\ Benzoic acid, mineral 
\ acids. 

Salicylic acid, salicylate 
of lithia. 

Daturine, hyoscyamine. 
j Hydrobromate of mor- 
\ phine. 

Morphine. 

Hyoscyamine. 
j Anodynes, bromide of 
\ camphor. 

Arseniate of strychnine. 

Ergotine. 

Aconitine. 

Arbutine. 

Surgical means. 



LumbagOo — See Rheumatism. 

Malaria. — See Paludal Infection. 

Meningitis, Cerebral. — The different varieties of 
meningitis may be considered, from a therapeutic stand- 
point, as essentially but one. In fact, whether we have 
simple, tuberculous, cerebral, spinal, or cerebro-spinal 
meningitis, we have the same element to tight in all of 
them — that is, the inflammatory element. In granular 
or tubercular meningitis, however, there is another ele- 
ment which is of great importance, but therapeutics is 
forced to neglect it, not only on account of the weakness 
of the arms which she wields against it, but also because 
it is generally the repeated inflammatory attacks which, 
above all other things, cause the danger which resides 
in this second or tubercular element. In how many 
cases, after an inflammatory attack has subsided, the 



ELEMENTS OF DOSIMETRIC PRACTICE. 365 

patient regains the appearance of health in spite of the 
persistence of the granulations, until a new inflamma- 
tion brings back the entire morbid scene ! The symp- 
toms of meningitis may be divided into two series, 
which constitute two allied phases. The first series 
presents symptoms of excitement which result from 
the hypersemic condition of the meninges ; the second, 
which is the natural consequence of the first, is derived 
from all the depressing results which follow every form 
of excessive excitement. By cutting off the inflamma- 
tion, which is accomplished by preventing hyperemia, 
we get control of the disease, in so far as the existing 
therapeutic agents will admit of such an event. In 
acute meningitis the dominant will, therefore, consist 
in the use of aconitine, in one-granule doses every quar- 
ter of an hour, until a decided antiphlogistic effect has 
been obtained. In chronic meningitis, and among those 
individuals who are predisposed to the disease by he- 
reditary or other influences, a plan of preventive treat- 
ment must also be adopted to prevent cerebral conges- 
tion, and for this purpose we should give three granules 
of cocaine three or four times daily, the effect of this 
drug being to relieve the congestion of nervous centers. 
Two to four granules of digitaline, with an equal quan- 
tity of aconitine, may also be given at bedtime, to allay 
the irritation which is so apt to be present at that time. 
Tuberculous meningitis can be cured. This assertion 
is based upon incontestable proofs pertaining to patho- 
logical anatomy. But to accomplish this result it is 
indispensable that for a long period there should be no 
aggravation of the existing lesions, which might quickly 
destroy the good effects of months of treatment. Here- 
in lies the great value of preventive treatment, when it 
is carried out for a sufficient length of time, and is re- 
enforced by appropriate hygienic, physical, and moral 
precautions. The abolition of the granulations (tuber- 
cles) can be tested by the same means as are used in 
testing for scrofula. It is not necessary to limit one's 



366 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

efforts to the treatment of lesions which are already- 
developed ; we should also improve the entire organism, 
so as to prevent the development of new lesions. To 
accomplish this end we should give three granules of 
juglandine three or four times daily, with two granules 
of iodoform and two of a suitable salt of arsenic three 
times daily. In some cases the intensity of the symp- 
toms will compel us to use other remedies than those 
which have been indicated in the treatment of the vari- 
ant. For the fever we should use aconitine persistently, 
and if there is no abatement after several days of treat- 
ment a granule of digitaline and one of vera trine should 
be added every quarter of an hour. If the fever is more 
or less intermittent we have a right to suspect that it 
may be of a pernicious character, and treat it with large 
doses of quinine ; five granules of the hydrobromate, 
with five of the hydroferrocyanate, may be given every 
quarter of an hour, a granule of the arseniate of strych- 
nine being added to each dose, not only on account of 
its energetic antiperiodic effect, but also because it will 
intensify the effect of the quinine. The troublesome 
headache of this disease should be treated with three 
granules of the bromide of camphor every half -hour, if 
aconitine does not suffice to allay it. Hyoscyamine will 
arrest the vomiting, but its physiological effects must 
be noted, for their intensity and the rapidity with which 
they are produced will vary greatly in different indi- 
viduals. In children we should begin by giving half- 
granule doses every half -hour, increasing or diminishing 
the quantity according to the effects which are first 
produced. Constipation may be corrected by the daily 
use of Sedlitz Chanteaud and one to three granules of 
hyoscyamine and of brucine every evening. For the 
contractures one granule of valerianate of atropine may 
be given every half -hour in acute cases, two granules 
three times daily in chronic ones, precautions with re- 
spect to tolerance of these different drugs being ob- 
served in all cases. The delirium will often disappear 



ELEMENTS OF DOSIMETRIC PRACTICE. 



367 



after defervescence has been accomplished by the aconi- 
tine ; if it persists, however, three granules of the bro- 
mide of camphor may be given every hour, or we may 
apply ice or iced water to the head. During the con- 
vulsions one to three granules of veratrine may be given 
every half-hour, unless the stomach should be unable 
to bear it, vomiting being excited. In such a case one 
granule of hyoscyamine should be given in preference 
every half -hour, or two granules of croton chloral every 
quarter of an hour. The paralyses may be either tem- 
porary or permanent. The former will yield to the use 
of one or two granules of the hypophosphite of strych- 
nine or of brucine every two or three hours. The same 
agents should be used during the entire period of de- 
pression, the activity of the treatment being regulated 
by the state of the pulse, and phosphoric acid being 
added if the vitality is much depressed. Permanent 
paralyses — that is, those which have already existed 
for some time when treatment is begun — will only be 
relieved, if at all, by the long-continued use of electro- 
therapy and suitable neurosthenic agents. Revulsives 
are of no use for this condition ; bloodletting is danger- 
ous ; the iodide of potassium, which is used so exten- 
sively by the official school, may be profitably replaced 
with iodoform, of which two to five granules may be 
given three times daily. 



H 

i— i 

i— i 

w ( 
pq 



( Inflammatory element . 
Dominant. •] Meningeal granulations 
( Scrofula 
( Fever . 

Intermittent attacks 



\ Variant. 



Cephalalgia . 
Vomiting 

Constipation 

Photophobia 
Delirium 
Contractures 
Convulsions . 



Temporary paralyses 
^ Chronic paralyses 



Aconitine. 

Juglandine. 

Iodoform, arseniates. 

Aconitine, digitaline, veratrine. 

Hydrobromate and hydroferro- 
cyanate of quinine. 

Bromide of camphor. 

Hyoscyamine. 

Se'dlitz Chanteaud, hyoscya- 
mine, brucine. 

Daturine. 

Aconitine, bromide of camphor. 

Valerianate of atropine. 

Veratrine, croton chloral. 

Hypophosphite of strychnine, 
brucine. 

Electricity, strychnine, phos- 
phoric acid. 



368 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Meningitis, Spinal,— In cases in which spinal 
meningitis is a primary and isolated condition, it 
should be attacked energetically, to prevent the inflam- 
mation from extending to the tissues which surround 
the inflamed meninges. This consideration is of the 
greatest importance, because, while meningitis is fre- 
quently curable, myelitis has not so favorable a prog- 
nosis. The dominant will consist in the use of aconi- 
tine until it has effected the complete subsidence of 
the inflammatory symptoms. The aconitine should be 
given with the view of checking the disease if possible, 
and, therefore, it should be administered every quarter- 
hour or every half -hour until the physiological or thera- 
peutic effects appear, which indicate that the activity 
of the treatment may be moderated. In chronic men- 
ingitis the treatment should not be as energetic as in 
the acute form ; consequently, we should give only two 
granules of aconitine three or four times daily, adding 
thereto as modifiers of the nutrition two-granule doses 
of arseniate of soda and of arseniate of strychnine three 
times daily. A rise in the temperature indicates a com- 
bination of the defervescents, aconitine, digitaline, and 
veratrine, one granule of each being given every quar- 
ter of an hour or every half -hour until the temperature 
is reduced. After this end has been attained, two gran- 
ules of the hydrobromate and of the hydroferrocya- 
nate of quinine should be given every half -hour to pre- 
vent the recurrence of the fever. The pain in the 
spinal cord, and radiating from it, is due to the ex- 
tension of the irritation and the compression of the 
sensory-nerve roots. In this condition we should add 
to the dominant the bromide of camphor in three-gran- 
ule doses every half-hour, or one granule of cicutine 
every quarter of an hour until a sedative effect has been 
obtained. Contractures, as well as dysphagia, dysp- 
noea, and spasmodic retention of the urine and faeces, 
are due to hyperkinesia, which is caused by irritation 
of the motor roots of the cord. Such a condition of 



ELEMENTS OF DOSIMETRIC PRACTICE. 



\M 



excitement may be relieved by using one grannie of 
hyoscyamine every two hours, or two of croton chloral 
every half-hour. For the hyperesthesia we should use 
two granules of the tannate of cannabine every half- 
hour, and for the paraplegia, which is almost always 
due to disturbance in the cord, revulsives and brucine 
internally, three or four times daily. 



m /Dominant. 



fell 



P3 \Variant. 



Inflammatory element 
I Fever . 

Pain 

Contractures 

Dyspnoea 
J Dysphagia . 

Retention 

Hyperesthesia 
\ Paraplegia . 



Aconitine. 
Aconitine, veratrine. 
Digitaline, quinine. 
Bromide of camphor, cicutine. 

Hyoscyamine, croton chloral. 

Tannate of cannabine. 
Brucine. 



Metritis,, — Acute inflammation of the uterus may 
arise from various causes, the most frequent of which 
are irritations which follow parturition. The presence 
of tumors, the retention of the menstrual fluid, and the 
use of irritant injections may also cause this condition. 
In the puerperal condition a chill, indicating the in- 
vasion of inflammation, should be the signal for begin- 
ning the treatment. We should seek to overcome the 
vaso-motor paralysis, which is the first cause of con- 
gestion, by the use of one granule of strychnine and 
one of phosphoric acid every quarter of an hour until 
reaction is established. After the febrile condition is 
established, which indicates that congestion has become 
inflammation, we should give one granule of aconitine 
every quarter- or half -hour until defervescence occurs. 
If the pulse is frequent and violent, we should combine 
with the aconitine one granule of digitaline every half- 
hour until the number of the pulsations has diminished. 
The febrile movement is often of an intermittent char- 
acter, and this symptom indicates the use of the hydro- 
ferrocyanate of quinine in two-granule doses every 
half-hour. The hypogastric pain, which in almost all 
cases radiates toward the lumbar region, the inguinal 

24 



370 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

region, etc., may be relieved, after the inflammatory 
element has been brought under control, by two gran- 
ules of the hydrobromate of cicutine or of croton chloral 
every half -hour. The constipation and diarrhoea will 
require the use of Sedlitz Chanteaud, at first in a purga ? 
tive dose, and afterward in small quantities. The vom- 
iting which appears as a reflex symptom of the uterine 
lesions may be checked by the use of two granules of 
the hydrochlorate of morphine every quarter of an 
hour, or three granules of codeine every ten minutes 
if the former is contra- indicated. Metritis often affects 
the sensibility of the rectum and bladder, causing a 
painful tenesmus, which will require for its relief a 
granule of hyoscyamine every two hours or less, ac- 
cording to the violence of the contractions. During 
the menstrual period the haemorrhage in some of these 
cases is sufficiently severe and protracted to require the 
use of means for arresting it. For such cases three 
granules of ergotine and three of the sulphate of qui- 
nine may be given every half -hour, the intervals be- 
tween the doses being gradually lengthened, as the cir- 
cumstances permit. Rest in bed and a suitable diet 
are indispensable to the rapid cure of acute metritis. 
Chronic metritis may be catarrhal or parenchymatous. 
This distinction, which is made by the pathological 
anatomist rather than by the clinician, depends upon 
the predominance of lesions in the mucous membrane 
in the one case, and in the interstitial tissue in the 
other. With respect to their symptoms, the two forms 
of disease are distinguished by a difference as to the 
frequency and the abundance of their haemorrhages, 
the quantity of the mu co-purulent discharge, and the 
degree of curability, the symptoms being more pro- 
nounced in the parenchymatous variety. The chronic 
form of the disease is due to a want of vaso-motor vital- 
ity. The dominant should, therefore, be the arseniate 
of strychnine or ergotine, two granules being given 
three or four times daily. The general debility, which 



ELEMENTS OF DOSIMETRIC PRACTICE. 371 

is a not infrequent accompaniment, should be treated 
with the salts of strychnine, while the anaemia, which 
is always more or less pronounced, calls for the salts of 
iron. The palpitations and dyspnoea, which are the 
result of a want of equilibrium in the nervous system, 
which attends all uterine diseases, become less trouble- 
some if a few granules of digitaline are taken daily ; 
two granules might be taken morning and evening. 
Irascibility and a tendency to hysteria may be modi- 
fied by exercise, by suitable diversions, and by the use 
of three granules of the bromide of camphor or of caf- 
feine three times daily. Want of regularity in the 
evacuation of the bowels should be persistently treated 
with the daily use of Sedlitz Chanteaud, either alone 
or associated with three to five granules of veratrine or 
podophyllin at night. Want of appetite should be 
treated with three granules of quassine or cubebine be- 
fore each meal ; a voracious or perverted appetite with 
three of codeine before each meal. For hypogastric 
pains, especially if they are characterized by exacerba- 
tions or radiation, two granules of tannate of cannabine 
should be given every half-hour until relief is obtained. 
Tenesmus should be treated with one granule of hyos- 
cyamine or one of sulphate of atropine every half-hour, 
as in the acute form of the disease. For an exagger- 
ated muco-purulent uterine discharge, we should give 
two granules of tannic acid four times daily, or two 
granules of iodoform and two of arseniate of iron three 
times daily, especially if the patients be of the lym- 
phatic diathesis. Metrorrhagia, which is sometimes 
quite troublesome, may be treated with ergotine ; but 
this does not always give the results which are desired, 
because the newly- formed blood-vessels in the adventi- 
tious tissue which pertains to the disease contain no 
contractile elements, and hence are not acted upon by 
the ergotine. Local haemostatics will, therefore, be 
required, such as ice, perchloride of iron, etc. For the 
irritability of the uterus two granules of cicutine may 



372 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



be given three times daily. If the proliferation of con- 
nective tissue has been very active, occlusion of the os 
internum may have resulted, with retention of the 
products of exudation. These can be removed by the 
use of the sound. Such are the means for treating the 
different forms of this disease, which is always a rebel- 
lious one. In some cases the cause must be sought in 
a particular diathesis appertaining to the individual, 
and treated with the proper remedies. All other agents, 
with the exception of hydrotherapy and some others of 
that order, should be avoided as very uncertain and 
often dangerous. 

METRITIS. 

Acute. 

Dominant. Inflammatory element . Aconitine. 

/ Chill ' Strychnine, phosphoric acid. 



Variant. ( 



Frequency of the pulse 
Febrile intermittence . 

Radiating hypogastric pain 

Constipation or diarrhoea . 
Vomiting .... 
Rectal or vesical tenesmus . 
\ Menorrhagia 



Digitaline. 

Hydroferrocyanate of quinine. 
j Hydrobromate of cicutine. 
( Croton chloral. 

Sedlitz Chanteaud. 

Hydrochlorate of morphine. 

Hyoscyamine. 

Ergotine, salts of quinine. 



Chronic (Catarrhal and Parenchymatous). 



Dominant. Paralytic element 
/Anaemia 

General debility . 

Palpitations, dyspnoea 

Hypochondria 

Constipation 

Want of appetite 
Variant. ( Hypogastric pain 

Tenesmus . 

Muco-purulent discharge 

Metrorrhagia 
Uterine irritability 
^Retention of secretions 



Arseniate of strychnine. 
Salts of iron. 
Arseniate of strychnine. 
Digitaline. 
Caffeine. 

Sedlitz Chanteaud. 
Quassine. 

Tannate of cannabine. 
Hyoscyamine. 

Tannic acid, iodoform, arseni- 
ate of iron. 
Ergotine. 
Cicutine. 
Use of sound. 



Metrorrhagia. — Metrorrhagia may be due to an 
excessive flow of blood to the uterus, which, by undue 
dilatation of the vessels, forces its way out, and thus 
terminates a powerful active congestion ; or to a lesion 
of the vessels, which may vary as to character, but which 
makes their walls less resistant than usual, and thus 
causes a haemorrhage with or without increase of intra- 



ELEMENTS OF DOSIMETRIC PRACTICE. 373 

vascular pressure. The type of the first form of haemor- 
rhage is menstruation ; of the second, the haemorrhage 
from cancer of the uterus. In both cases the haemor- 
rhage is due to a want of vascular resistance, and to 
weakness in the contractile power of the coats of the 
vessels. The dominant in metrorrhagia will therefore 
be filled by medicaments which directly excite vascular 
contractility or the contractility of the uterine tissue, 
which by contracting will compress the torn vessels 
and diminish their caliber, thus facilitating the forma- 
tion of clots and leading to complete haemostasis. 
Ergotine, strychnine, and quinine are the agents which 
correspond to these indications, aconitine being associ- 
ated with them whenever hyperaemia is manifest. 
Three to five granules of ergotine should be given with 
one of sulphate of strychnine every quarter of an hour 
until the haemorrhage begins to abate ; then the inter- 
vals between the doses may be lengthened, and the 
medicaments be finally discontinued when the danger 
seems to be over. The quinine should be given as a 
synergist of the ergotine ; three granules of the hydro- 
ferrocyanate or the valerianate being given every 
quarter of an hour, if there is any pain ; similar quanti- 
ties of the hydrobromate, if there are irregular contrac- 
tions ; and live granules of the sulphate at a dose in 
other conditions, the dosage being gradually dimin- 
ished, and the intervals lengthened as the effect be- 
comes more evident. After haemostasis has been 
obtained, quassine and arseniate of iron should be given 
to hasten convalescence. For some days after the 
haemorrhage has occurred, the patient may be in a state 
of physical and moral prostration. At such times 
straining at stool must be carefully avoided, and Sedlitz 
Chanteaud may, at this juncture, be taken with advan- 
tage to facilitate intestinal evacuations. An auxiliary 
agent of tried efficiency consists in the use of vaginal 
douclies of water as hot as can be borne by the patient. 
In addition to removing the accumulated clots from 



374: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

the vagina, they will relieve the congestion of the sur- 
rounding tissues and facilitate uterine contractility. 

Ergotine, strychnine, quinine. 

Aconitine. 

Hydrobromate of quinine. 

Quassine, arseniate of iron. 

Sedlitz Chanteaud. 



i j f Dominant. Muscular atony 
O m J f Hypersemia 

<A ~j 1 Irregular contractions 

mW IV ARIANT - \ Weakness following 
Sp^ haemorrhage . 

[ Constipation 



Myelitis. — From the standpoint of pathological 
anatomy, diseases of the spinal cord have called forth 
profound and minute investigations, and the result of 
this has been a classification with which it may be de- 
sirable to be familiar, though it may also be of little 
value in establishing a rational and effective plan of 
treatment. From the clinical point of view, all the 
forms of myelitis can be united into a single group, for 
the prognosis, which is grave in all of them, and the 
treatment, which offers equally uncertain results for all, 
authorize such a course, though the diseases vary greatly, 
as well in respect to their progress as in their anatomical 
substratum. The following table, which is borrowed 
from Grasset on account of the clearness of its arrange- 
ment, will serve as a guide to those who wish to make rig- 
orous diagnoses of the different varieties of the disease : 



I. SYSTEMATIC OR PARENCHYMATOUS MYELITIS. 

(Its various forms begin in the nerve-elements, and become localized in 
particular departments of the nervous system.) 

A. Pertaining to the White Matter {fasciculated sclerosis). 

1. In the exterior portion ( a. Primary : progressive lo- 
ot the posterior columns : ■< comotor ataxia, 
posterior radicular zones { b. Secondary. 

/ a. Primary : sclerosis of the 
columns of Coll. 
b. Secondary, result of a 
lesion of the cord : second- 
ary ascending sclerosis. 

a. Without muscular atro- 
phy : spasmodic tabes dor- 
salis. 

b. With muscular atrophy: 
amyotrophic lateral scle- 
rosis. 

2. Secondary, in consequence of sclerosis of the brain or 
of the cord : secondary descending sclerosis. 



In the posterior 
columns ^ 



In the lateral 
columns, and 
columns of 
Turck . 



2. In the internal portion 
of the posterior columns . 
the columns of Goll 



Primary : symmetrical 
lateral sclerosis . 



ELEMENTS OF DOSIMETRIC PRACTICE. 



375 



B. Pertaining to the Gray Matter. 



In the anterior 
columns 



In the bulbar 
foci . 



Primary 



1. Chronic : progressive mus- 
cular atrophy. 

2. Acute : a. In children : 
infantile atrophic paraly- 
sis, b. In adults : acute 
spinal paralysis. 

Secondary, as the result of a precedent myelitis : second- 
ary spinal amyotrophy. 

Primary : labio-glosso-la- j Simple, 
ryngeal paralysis . . ( With muscular atrophy. 

Secondary, as the result of different forms of myelitis : 
symptoms of bulbar involvement in amyotrophic lat- 
eral sclerosis, in diffuse myelitis, etc. 



II. DIFFUSE OR INTERSTITIAL MYELITIS. 

(Its varieties begin and are developed in the connective tissue, and invade, 
indifferently, all the regions of the cord.) 

A. Acute. 

/ Fulminant apoplectiform . 
tvpe .... 
/ Fatal. 
Susceptible of 

cure. 
Subject to re- 
lapses, with 
passage into 
the chronic 
state. 
( Supra-acute type. 
(Acute ascend- -j Acute type, 
ing paralysis) ( Sub-acute type. 



Not diffuse : 

(Circumscribed, / 
more or less 
extensive) . 



Acute or 
sub-acute { 
types 



Varieties : 
Dorso-lumbar, or cervical. 
( Complete, or hemi-lateral. 
Central, or peripheric. 



Diffuse : 



Not diffuse : ( Complete . 
(Circumscribed) ( Hemi-lateral 



B. Chronic. 



; / 



Type with ascending 
velopment . 



Type with descending de- 
velopment . 



Dorso-lumbar. 
Cervical, 
f Complete lesions. 
Lesions in the gray sub- 
de- stance predominating ; an- 
terior spinal paralysis of 
Duchesne, peri-epididymar 
myelitis of Hallopeau. 
( Lesions in the white sub- 
stance predominating ; an- 
1 nular cortical myelitis of 
[ Trousseau and Vulpian. 
I Sclerosis en plagues. 

Particular forms •] Progressive general paraly- 

( sis. 

All that we need retain of the foregoing is that 
myelitis may be parenchymatous or interstitial, accord- 
ing as the nerve-cells or the connective tissue is in- 
volved ; also, that it may be propagated as the result 



Diffuse : 

(Sub-acute spi- 
nal paralysis 
of Duchesne ; 
diffuse gen- 
eralized mye- 
litis of Hallo- 
peau) . 



376 ELEMENTS OF THERAPEUTICS AND PRACTICE, 

of intra- or extra-medullary tumors, of traumatic vio- 
lence, of excess or fatigue, as a result of cold, of irrita- 
tion of the peripheral nerves, of poisoning, or of general 
diseases. The bearing which a knowledge of these 
causes has in each particular case is very important, 
for no method of treatment will succeed if we do not 
at the same time suppress the original cause of the 
disease. With reference to some of these causes we 
are powerless ; with others — for example, traumatism 
or syphilis — we can hope for good results from treat- 
ment. Medullary lesions begin and almost always 
increase by the medium of hyperemia. We should, 
therefore, establish a preventive plan of treatment, 
which will avoid all conditions which are capable of 
exciting spinal congestion. To a suitable hygienic 
treatment we should add means which are appropriate 
for moderating the circulation and calming the excited 
condition of the nerve-centers. These two indications 
will be filled by aconitine and cicutine, two to four 
granules of each being given every evening. The domi- 
nant treatment of myelitis in acute cases will consist 
in the use of the defervescents, one granule each of 
aconitine, veratrine, and digitaline being given every 
half -hour. In chronic cases the actual cautery may be 
used, and as modifiers of the nutrition two granules of 
iodoform and of arseniate of soda three or four times 
daily. The variant in the treatment of this disease 
amounts to little, for the symptoms are the result of 
certain lesions which can not be extensively or favor- 
ably modified. Still, though we may not hope for a 
complete and lasting relief, it will at least be possible 
to diminish the pain of this disease and make it sup- 
portable. The paraplegia induced, by this disease is 
incurable after it is established ; its occurrence may be 
delayed, however, and its aggravation prevented in 
some cases by the use of two granules of the hypophos- 
phite of strychnine three times daily, or two of phos- 
phoric acid three or four times daily, or three of the 



ELEMENTS OF DOSIMETRIC PRACTICE. 377 

phosphide of zinc three or four times daily. The pains, 
which most frequently take a darting or fulgurating 
character, may be relieved by the use of three granules 
of the hydrobromate of cicutine or of morphine every 
quarter of an hour, or two of croton chloral every quar- 
ter of an hour. Paralysis of the rectum may give rise 
either to fecal retention or incontinence. In the first 
case three granules of podophyllin may be given every 
hour, combined with one or two of sulphate of strych- 
nine, to overcome the torpor of the intestines ; in the 
second case five of ergotine, with two or three of the 
hypophosphite of strychnine, may be given three times 
daily. If retention of the urine can not be overcome 
by the use of the neurosthenics, with one granule of 
hyoscyamine every hour, catheterism must be resorted 
to, and this may excite a more or less intense cystitis. 
The careful disinfection of catheters must always be 
insisted upon, and three granules of benzoic acid or the 
benzoates may be given three times daily, to prevent 
the ready decomposition of the urine. Incontinence of 
urine should be treated in the same way as fecal incon- 
tinence, and for this condition rubber urinals are in- 
dispensable. Anaesthesia should be treated by means 
of the constant electric current, and hyperesthesia by 
three granules of croton chloral every three hours, or 
two of the tannate of cannabine every hour. The vis- 
ceral perturbations which are caused by medullary 
lesions — for example, gastralgias, laryngopathies, etc. 
— may be cured by the use of antispasmodics, either 
one granule of hyoscyamine being given every half- 
hour, or two of the bromide of camphor every half- 
hour. The diathetic conditions which most frequently 
give rise to myelopathic phenomena are syphilis and 
rheumatism ; in the former, three to five granules of 
iodoform and an equal quantity of biniodide of mer- 
cury should be given three times daily ; in the latter, 
two granules of colchicine and an equal quantity of 
salicylate of soda three times daily. Every one knows 



378 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



that scleroses never retrograde, but constantly tend to 
invade healthy tissue by an irresistible proliferation of 
the interstitial connective tissue. The physician should, 
therefore, be careful about promising the patient any 
success which he knows is impossible. He must con- 
tent himself with resisting the progress of the disease, 
and accept the existing lesions as an accomplished fact. 
Whatever can be obtained beyond this must be looked 
upon as the result of good fortune and the patient 
application of preventive treatment combined with the 
uninterrupted use of curative means. 

TREATMENT OF MYELITIS. 

Preventive. 
Hyperemia 



Dominant, 



■! 



Variant. ( 



Excitability . 

Curative. 
Acute myelitis 
Chronic myelitis 

( Paraplegia 

Pain 

Fecal retention 

Retention of 
urine . 

Symptomatic' f^cal inconti- 
nence . ♦ 

Incontinence of 
urine . 

Anaesthesia . 

Hyperaesthesia 

Visceral per- 
\ turbations . 

c Syphilis . « 

( Rheumatism . 



Aconitine. 
Cicutine, 



digita- 



j Aconitine, veratnne, 
I line. 

j Revulsives, iodoform. 
( Arseniate of soda. 

{Hypophosphite of strych- 
nine, phosphoric acid, 
phosphide of zinc. 
j Morphine, cicutine, croton 
( chloral. 

j Podophyllin, sulphate of 
/ strychnine. 

t Catheterism. 



Ergotine. 
Hypophosphite 



of strych- 



Causal 



Electricity. 

Croton chloral. 

Tannate of cannabine. 

Hyoscyamine, bromide of 
camphor. 

Iodoform, biniodide of mer- 
cury. 

Colchicine, salicylate of soda. 



Nephritis,, — Inflammations of the kidneys differ as 
well in respect to their intensity as to the tissues which 
are first invaded or are most severely affected. The 
inflammatory element, which is the common basis of 
all morbid conditions of this character, gives to all a 



ELEMENTS OF DOSIMETRIC PRACTICE. 379 

common dominant. Whether the form of nephritis 
be epithelial, parenchymatous, interstitial, acute, or 
chronic, the dominant indication will always be satis- 
fied with aconitine. Epithelial (tubal) nephritis, 
whether idiopathic or deuteropathic, should always 
receive treatment until one is certain as to its complete 
resolution. In consequence of a want of energy in the 
treatment, or the following of an expectant plan of 
medication, an insignificant degree of inflammation 
may remain, which is insufficient to reveal the exist- 
ence of the disease, but is of sufficient importance to 
serve as a point of departure, perhaps long afterward, 
for an extension of the disease which may prove in- 
curable. In chronic nephritis or chronic Bright's dis- 
ease aconitine is equally indicated, not only on account 
of the renal lesion per se, but also on account of the 
extension of the disease to the entire arterial system. 
This localization in the circulatory apparatus indicates 
the combination of aconitine with digitaline. The doses 
should vary with the condition of the renal function. 
In epithelial nephritis, in which the difficulties of elimi- 
nation are not great, aconitine may be combined with 
digitaline in doses of one granule of each every three 
or four hours, the results of the treatment being 
watched with the greatest care that the physiological 
effect of the drugs employed may not be exceeded. 
The treatment of interstitial nephritis should be much 
less active, because the eliminative function in this 
variety of nephritis is imperfect, and hence accumula- 
tion of the medicaments is more likely to occur than 
in the other forms. Three doses daily will usually be 
sufficient in this form of the disease. Acute nephritis 
is always accompanied with a rather high temperature, 
and this indication of the variant may be satisfied with 
aconitine, the dosage of which must be regulated by 
the degree of elevation of the temperature. One gran- 
ule may be given every half-hour or every hour, the 
thermometer being frequently used to guard against 



380 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

toxic effects from overdosage. In typhoid fever, which 
is usually accompanied by infectious nephritis, the or- 
dinary dose is one granule every half -hour or even 
every quarter-hour, and no danger attends such admin- 
istration. The markings of the thermometer are infalli- 
ble guides for regulating the activity of treatment in 
these cases. Pain in the renal and lumbar regions may 
be quieted, as in all inflammations, by means of seda- 
tives and antispasmodics. Usually two granules of 
codeine every quarter-hour, or two of cicutine every 
half-hour, will suffice to control this symptom. If the 
urine is scanty and heavy, it may be increased in quan- 
tity by the use of the physiological diuretics, water 
and milk. One to three granules of arbutine every 
three hours will also be of service for this purpose. 
In chronic nephritis there are also certain symptoms 
which, though inconstant, are of sufficient importance 
when present to demand rapid and immediate treat- 
ment. In the greater number of cases the cause of 
these symptoms is the accumulation of urea in the 
blood, and they serve as a warning that these products, 
which are retained in the body on account of defective 
renal purification, must be eliminated. In the early 
stages of the disease the intestinal mucous membrane 
may have a compensatory action for the insufficiency 
of the kidneys. In this condition a saline laxative, by 
producing an abundant transudation of serum, will 
bring the blood into the most favorable condition which 
is possible. Sedlitz Chanteaud, sulphate of soda, etc., 
will serve as the most efficient remedies for headache, 
dyspnoea, and convulsions. In addition to the laxa- 
tives, we should give some agent which will act directly 
upon the affected part, and relieve suffering. There- 
fore, for the headache we may administer two granules 
of the valerianate of caffeine every half -hour ; for the 
dyspnoea, two granules of the hydrobromate of cicutine 
every hour, or one of digitaline every quarter-hour ; 
for the convulsions, two granules of the bromide of cam- 



ELEMENTS OF DOSIMETRIC PRACTICE. 



181 



phor or the valerianate of zinc every half -hour, each of 
these remedies being repeated until the desired effect 
has been obtained. By these means we may be enabled 
to overcome the complications, and relieve the suffer- 
ings of the patient even in cases in which the laxatives 
have had no effect. (Edema must be treated with 
tonics and diuretics ; and milk, with three granules each 
of the arseniate of iron and arseniate of strychnine 
daily, will give better results than all other means of 
treatment. Albuminuria calls for no particular treat- 
ment ; it will disappear with the disappearance of the 
lesion which caused it. Astringent medication by 
means of tannic acid, perchloride of iron, etc., will 
only serve to modify the digestive functions without 
materially changing the condition of the blood. Urae- 
mia calls for no other treatment than the production 
of copious serous discharges. Diaphoretics and purga- 
tives will have only a transient effect. Purgatives 
should always be preferred, because diaphoretics have 
a much more depressing action upon the vital forces, 
and thus cause the patient to lose all the beneficial 
effects of the sweating. Yesicants, cups, and revulsives 
in general should not be used, for they seldom pro- 
duce any positive effect, and almost always aggravate 
the condition of the patient. 

NEPHRITIS. 



Dominant 



Variant. 



/Acute 



\ Chronic 



Inflammatory condition 
Fever . * . . 
Pain 
Urine 

( Cephalalgia 
Dyspnoea . 
Convulsions 

(Edema . 

Albuminuria . 
^ Uraemia . 



Aconitine, digitaline. 

Aconitine. 

Codeine, cicutine. 

Milk, water, arbutine 

Valerianate of 
caffeine. 

Hydrobromate 
of cicutine. 

Bromide of 
camphor. J 

Arseniate of iron. 

Arseniate of strych- 
nine. 

Aconitine, digitaline. 

Laxatives, diaphoret- 
ics. 






382 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Neuralgia. — Neuralgia, or algesia, consists in an 
exaltation of function of the sensory nerves. It may 
arise: 1. From a more or less appreciable material 
alteration in the structure of the nerves. 2. From a 
dynamic alteration in the nerve - force. 3. From a 
change in the blood-supply of the nerves, in a quantita- 
tive sense. 4. From a qualitative change in the blood- 
supply, either in consequence of diseases arising from 
disorders in the blood and diathetic disturbances, or in 
consequence of toxic influences. The general treatment 
of hyperalgesia, or neuralgia, consists in the use of 
anodynes, especially morphine ; but the function of this 
drug is rather to obtund the sensibility with respect 
to pain than to modify the causative lesions. For this 
reason, after the sedative effect has passed away, the 
pain frequently returns with greater violence than be- 
fore. It becomes necessary, therefore, to make a 
further search with respect to the pathogenesis of neu- 
ralgia, and the manner in which the pain is established, 
in order to be able to use therapeutic agents with 
greater effectiveness. The dynamic forms of neuralgia, 
which are especially prevalent among hysterical and 
neuropathic subjects, will yield most readily to the 
physiological modifiers of vitality, such as hydrother- 
apy, electricity, exercise, diverting employment, and 
moral influences. As they almost always result from a 
want of equilibrium in the vital forces, we may add to 
the foregoing agents a granule of the arseniate of 
strychnine and one of hyoscyamine three to five times 
daily. The mobility of these forms of neuralgia teaches 
us that we may obtain great results by the use of sim- 
ple means ; the difficulty lies in the choice of the means. 
At one time a neuralgia will yield to the influence of a 
warm bath ; the very next day it may yield to nothing 
but a cold douche. The laws of the correlation of vital 
forces, as manifested in the facts of dynamogenesis and 
inhibition, according to the investigations of Brown- 
Sequard, explain these apparent contradictions. Neu- 



ELEMENTS OF DOSIMETRIC PRACTICE. 383 

ralgias which arise in consequence of lesions in the 
structure of the nerves are almost always the result of 
an inflammatory process. In recent cases the most use- 
ful curative agent will be found in aconitine, one gran- 
ule being given every hour, or oftener if the pain is 
very severe. In chronic neuritis the best results will 
be obtained with revulsives, linear cauterizations, and, 
in very obstinate cases, surgical operations upon the 
nerves, whether neurotomy, neurectomy, or nerve- 
stretching. Before resorting to surgical procedures, 
however, we should try the various agents which have 
a modifying effect upon the nerves in a regular and 
methodical manner until we are convinced of their in- 
effectiveness. Congestion of the nerves is as common 
a cause of neuralgia as anaemia of the nerve-centers. 
If congestion is the efficient cause, two granules of 
aconitine should be given three or four times daily ; if 
anaemia, two granules of arsenious acid or the arseniate 
of iron, combined with an equal quantity of the hydro- 
chlorate of morphine, should be given three to five 
times daily. Changes in the blood may produce neu- 
ralgia, which will be more or less persistent in charac- 
ter. One of the most frequent of the causes of this 
character is chlorosis. The treatment should be six to 
ten granules of arsenious acid daily, or a similar quan- 
tity of the valerianate of iron. The paludal, syphilitic, 
and arthritic diatheses are also frequent causes of neu- 
ralgia. The treatment should be five to ten granules 
of the hydrobromate of quinine four times daily, or two 
to twenty granules of iodoform daily, and two granules 
of the cyanide of zinc or two of colchicine four times 
daily. Neuralgia which is caused by any form of in- 
toxication will disappear with the suppression or elimi- 
nation of the cause, and for this purpose the appropri- 
ate means should be used, an enumeration of which is 
unnecessary. The location of a neuralgia will some- 
times indicate a different treatment from that which 
would be appropriate for one which is differently lo- 



384 ELEMENTS OF THERAPEUTICS AND PRACTICE, 

cated, because certain agents have a more positive an- 
algesic effect upon some nerves than upon others. Neu- 
ralgia in the plantar region should be treated with 
applications of the tincture of iodine combined with 
morphine. Internally three granules of croton chloral 
may be given every half-hour, or two of cicutine every 
half-hour until a useful effect has been obtained. Sci- 
atica, when it is idiopathic in character, may be treated 
with two granules of gelsemine every half-hour, or two 
of tannate of cannabine. Sciatica, which is a symptom 
of a myelopathy, is a very rebellious form of neuralgia, 
and may not be entirely overcome until the principal 
morbid process has been controlled. Visceralgia in its 
various forms, which is almost always accompanied by 
a more or less decided condition of spasm, requires two 
granules of the hydrochlorate or the hydrobromate of 
morphine every quarter-hour, with the addition of a 
granule of the sulphate of atropine every half-hour. 
Odontalgia may be temporarily relieved by the use of 
one granule of aconitine every hour, or two of gelse- 
mine every quarter-hour, or two of cocaine dissolved 
in the mouth, and repeated every fifteen minutes until 
the pain ceases. If the teeth are much decayed, by 
pulverizing one or two granules of morphine, and ap- 
plying the powder to the decayed tooth, the pain will 
usually be relieved. The internal use of the alkaloids 
of opium in this condition is not indicated, as they 
tend only to increase the cranial congestion. Proso- 
palgia, one of the most painful and most rebellious of 
neuralgic affections, will almost always yield to the use 
of two granules of aconitine three to five times daily. 
The ammoniacal sulphate of copper may also be given 
with good results, two centigrammes dissolved in water 
being given five to ten times daily. Tic douloureux 
may be treated with one granule of atropine and one 
of aconitine every hour until the pain is relieved. The 
internal treatment may be supplemented by the ex- 
ternal use of the ether spray. Hemicrania requires 



ELEMENTS OF DOSIMETRIC PRACTICE. 



385 



treatment of a particular character, which consists in 
the use of two granules of guaranine every half -hour 
during the attack, and three granules four or five times 
daily in the intervals between the attacks. This treat- 
ment must be kept up several months in succession, 
the doses being gradually diminished, and finally dis- 
continued. 

NEURALGIA. 



Dominant. 






With change f D . 

in the nerv- ■< ' 

ous system ( Inflammatory . 
With change ( Congestive 

^"i*-* • • • 

{Chlorotic 
Muda 
Paludal 

I Toxic 



Hydrotherapy, electricity. 

Hyoscyamine, strychnine. 

Aconitine, surgical means. 

Aconitine. 

Arsenious acid, arseniate of iron. 

Plydrochlorate of morphine. 

Valerianate of iron. 

Iodoform. 

Colchicine, cyanide of zinc. 

Hydrobromate of quinine. 

Treatment and suppression of the 



Variant. 



Plantar neuralgia 

Sciatica » 

Visceralgia 

Odontalgia 

Prosopalgia 

Tic douloureux . 
Hemicrania 



Tincture of iodine, croton chloral, 
cicutine. 

Gelsemine, tannate of cannabine. 

Hydrochlorate of morphine, atro- 
pine. 

Gelsemine, aconitine, cocaine. 

Aconitine, ammoniacal sulphate of 
copper. 

Atropine, aconitine. 

Guaranine. 



Obliteration of the Arteries of the Brain 

{Cerebral Softening). — Therapeutics has little to do 
when the vessels of the brain have been obliterated. 
There are lesions of such a character that we can in no 
way prevent their production, but we may prevent 
some of their effects, and for that reason the following 
observations will be limited to the statement of certain 
indications respecting the variant in this condition. 
Arterial thrombosis almost always proceeds from an 
atheromatous condition of the arteries. The atherom- 
atous process is essentially a chronic one, and can be 
affected by treatment only to the extent of retarding 

25 



386 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

its progress to a slight degree, tlie aim of treatment 
being the quieting and regulating of the general circu- 
lation, and the preservation of the normal character of 
the blood. Two or three granules each of aconitine 
and digitaline should be given every evening, and in 
the morning the intestines should be relieved by the 
aid of a dose of Sedlitz Chanteaud. Obliteration by 
thrombosis usually occurs gradually ; its symptoms, 
therefore, are also manifested gradually. Consequently, 
its existence may be suspected and a coercitive plan of 
treatment adopted accordingly. The case is not the 
same when the obliteration is caused by embolism, 
which arises almost exclusively from affections of the 
heart and large vessels. In this condition the symptom- 
atic phenomena appear suddenly, the patient falling 
into an apoplectic condition. The first step in the 
treatment will consist in fortifying the nervous system 
against the consecutive lesions of function and nutri- 
tion, which are due to interruption of the circulation. 
Hypophosphite of strychnine should be given from the 
outset, the proper dose being two granules three or 
four times daily. The congestive symptoms, which are 
caused by excessive collateral fluxion, should be con- 
trolled by the use of one granule of aconitine every 
hour during the first few days, and two granules three 
or four times daily at subsequent periods. For the 
headache, two granules of the valerianate of caffeine 
may be given every half-hour. Disturbances of the 
intellect, such as amnesia, hallucinations, etc., may 
sometimes be modified, especially if they depend upon 
functional lesions, by the administration of one granule 
of hyoscyamine combined with one of strychnine every 
three hours. Paralysis should be treated with two 
granules of phosphoric acid and two of the arseniate 
of strychnine three or four times daily. Contractures, 
if of recent origin, may be made to disappear under the 
use of one granule of hyoscyamine and two of bromide 
of camphor four to six times daily. Vomiting, which 



ELEMENTS OF DOSIMETRIC PRACTICE. 



387 



sometimes accompanies obliteration from embolism, 
should be treated with two to four granules of codeine, 
dissolved in water, every half-hour. For vertigo, two 
granules of caffeine should be given every half -hour, or 
similar quantities of guaranine. 



OBLITERATION OF THE CEREBRAL ARTERIES. 



Dominant. 



Variant. 



Atheromatous arteritis 
Diseases of the heart . 
/ Disturbance in the nervous 
system .... 
Congestion .... 
Cephalalgia .... 
Disturbance of the intellect 

Paralysis .... 

Contractures 

Vomiting .... 



j Aconitine, digitaline. 
J Sedlitz Chanteaud. 

Hypophosphite of strychnine. 

Aconitine. 

Valerianate of caffeine. 

Hyoscyamine, strychnine, 
j Phosphoric acid, arseniate of 
/ strychnine. 

j Hyoscyamine, bromide of cam- 
( phor. 

Codeine. 



Occlusion of the Intestines.— Intestinal occlu- 
sion is due to opposition to the progress of the contents 
of the intestines, from causes which may reside within 
the intestinal cavity, in the walls of the intestine, or 
outside the intestine. DoKger classifies the causes of 
intestinal occlusion in the following manner : 



1. From organic diseases 
of the intestinal walls . 



2. From a lesion of posi- 
tion of the intestinal 
walls ► 



3. From strangulation . 



4. From foreign bodies . 



1. 
2. 
3] 

4. 
5. 
6. 
1. 
2, 
3. 
1. 

2. 

3. 

4. 

/I- 
2. 
3. 
4. 

\ 1. 



Inflammatory occlusion. 

Cicatricial occlusion. 

Hypertrophic occlusion. 

Valvular oc&lusion. 

Occlusion from the presence of a polypus. 

Occlusion from cancer. 

Invagination. 

Torsion. 

Sudden flexion. 

Internal herniae into the diaphragm, ab- 
normal openings of the mesentery. 

Strangulation of the ileo-caecal appendix, 
or some other portion of the intestine. 

Strangulation of a fold of the peritonaeum. 

Strangulation of intestine by intestine. 

Calculi \ V ll } ar J' , 
} intestinal. 

Foreign bodies. y Internal. 

Intestinal worms. 

Hardened fecal matter. J 

Pressure of the kidney, the ""j 
uterus, or some other organ | 
upon the intestine. y External. 

Pressure upon the intestine by 
an abdominal tumor. 



388 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

All these causes may give rise to occlusion of differ- 
ent degrees of intensity, its three types being recognized 
as invagination, contraction, and strangulation. The 
symptoms of these three types are different, and must 
be borne in mind in order to establish the diagnosis 
with exactness, upon which the efficiency of the treat- 
ment very often depends. Evidences of invagination 
are vomiting of bile, and sometimes of fseces ; there is 
seldom complete inability to evacuate the intestines, 
and the discharges are of a diarrhceal, fetid, and san- 
guinolent character. Tenesmus and contractions of the 
anus are sometimes very troublesome ; the abdomen is 
retracted at first, and afterward slightly tympanitic; 
the abdominal tumor is cylindrical, double, and tends 
to project during the periods of colic rather than in the 
intervals of repose. In making a diagnosis of strangu- 
lation, it is important to be acquainted with the ante- 
cedent conditions. These may have consisted in dis- 
eases of the intestine, a cachectic condition, frequent 
attacks of diarrhoea alternating with constipation, and 
an abdomen which is constantly dilated ; vomiting and 
tympanites are also symptoms which must be taken 
into consideration. True strangulation is characterized 
by precedent peritoneal inflammation, with subsequent 
intense pain, obstinate vomiting, constipation, occa- 
sional discharges of blood from the anus, and absence 
of tumor. Such are the differential symptoms given 
by Besnier, and, though they have no absolute value, 
they may serve to fix the diagnosis in the majority of 
cases. The relative frequency of the different forms of 
strangulation, as given by statisticians, may also be of 
assistance in making a differential diagnosis. Brinton, 
in an analysis of six hundred cases of occlusion, found 
that invagination was present in forty-nine per cent, 
and torsion or volvulus in only eight per cent. The 
most reliable signs of this condition are those which are 
derived from the progress of the accidents, from the 
precedent circumstances, and the age of the patient. 



ELEMENTS OF DOSIMETRIC PRACTICE. 389 

With the possession of all these facts the diagnosis is 
seldom anything but a probability. The diagnosis of 
the seat of the obstruction is of less importance for 
treatment by means of drugs than it is for surgical in- 
tervention. In all cases a digital exploration of the 
rectum should be made, for this will not infrequently 
reveal to us the cause of the accident, and the curative 
indication as well. Whatever be the pathogenic variety 
of the occlusion, the principal lesion is always the same, 
and the dominant indications almost identical in all. 
Occlusion may be attributed to two causes — a dynamic 
or an organic one. Dynamic occlusion, which results 
from spasmodic constriction of the intestine or from 
arrest of the contents of the intestine in consequence 
of intestinal paralysis and continued accumulation, may 
easily be overcome in the first instance by hyoscya- 
mine, and in the second by strychnine. As the two 
elements of spasm and paralysis are almost always as- 
sociated, however, these two remedies may be given 
simultaneously, the effect obtained being more certain, 
more mild, and more constant than when they are given 
separately. They are also better tolerated, and may 
be continued until a therapeutic effect is obtained, 
unless the obtaining of a physiological or toxic effect 
should compel their suspension. Likewise, in strangu- 
lation from organic causes excellent results may be ob- 
tained from these two alkaloids, and their administra- 
tion should be begun in one-granule doses every quar- 
ter-hour, and continued until the intra-intestinal circu- 
lation is re-established, and the pains cease, or until 
the extreme dilatation of the pupils and the beginning 
of delirium admonish us that their use must be discon- 
tinued. Let us suppose, for example, an occlusion 
from strangulation which is due to cancerous disease 
of the intestine. In most cases the obstruction can be 
overcome for the first few times, and the fecal matter 
discharged. In such a condition the obstruction is evi- 
dently not due altogether to the organic stricture, other- 



390 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



wise the difficulties of the situation would not have 
been overcome by the means used. The caliber of the 
intestine is made narrower by the organic disease, and 
yet narrower if there is the slightest spasm, or an ac- 
cumulation of fecal matter, as the result of insufficient 
contractile force. The same treatment which was used 
in dynamic occlusion is, therefore, appropriate in this 
condition, and will be crowned with the same results 
as if the lesion were purely vital. Unfortunately, the 
time comes when the strangulation becomes entirely 
organic, and no pharmaceutical means have yet been 
discovered for overcoming this variety of strangulation. 
A bad prognosis must, therefore, be given in those cases 
of occlusion which resist such a plan of treatment as 
has been indicated. Nothing but immediate surgical 
intervention can now be of service in saving the patient. 
The accompanying enteralgia should be treated with 
morphine, however. This will not only increase the in- 
testinal contractility, but it will greatly aid the effect of 
the antispasmodics which may have been administered 
— an effect which is much more difficult to obtain when 
violent pain is constantly exciting muscular irritability. 
Three granules of the hydrochlorate or the hydrobro- 
mate of morphine may be given every ten minutes until 
the patient is relieved. No particular treatment can 
be suggested for fecal vomiting, and, when this condi- 
tion exists, it is desirable that the alkaloids which have 
been recommended be given in iced water, or subcu- 
taneously in solution, to prevent their rejection. After 
the pain has ceased, it will be proper to add to each 
dose of hyoscyamine and strychnine three to five gran- 
ules of podophyllin, which will be slow in its action, 
but will prove to be a benefit rather than an injury. 
The purgative effect will be aided by the use of occa- 
sional draughts of a solution of Sedlitz Chanteaud. 
Meteorism will disappear only with an improvement in 
respect to the occlusion ; but, as it is the cause of sec- 
ondary disturbances, such as hiccough and dyspnoea, 



ELEMENTS OF DOSIMETRIC PRACTICE. 391 

it should be combated with local means, the best of 
which is ice, which should be kept constantly upon the 
abdomen. Punctures of the intestines are rarely indi- 
cated, not only on account of their danger, but because 
they are usually ineffective. Rectal enemata for the 
purpose of exciting contractility, or exerting a counter- 
pressure to that of the obstruction, are sometimes use- 
ful, and are not accompanied with danger. In prefer- 
ence, however, fifty grammes of Sedlitz in solution may 
be given, or a quantity of carbonated water may be in- 
jected by means of an oesophageal catheter. Enemata 
of tobacco are very dangerous, and so are such heroic 
measures as the use of metallic mercury in quantity, 
croton-oil, etc. 



so 

5° 



fsnasm \ Hyoscyamine, sulphate of 



f Dominant.^ paralysis 

[ Organic lesions 
f Enteralgia . 

V— ■ "fentiin 
[_ Meteorism . 



atropine. 
Strychnine. 
Surgical treatment. 
Morphine. 
Ice. 

Podophyllin. 
Ice. 



(Edema of the Glottis (Laryngeal Infiltration). 
— Laryngeal infiltration and oedema of the glottis can 
not be entirely identical conditions, because the larynx 
is not the glottis, and all infiltrations are not serous 
in character. Clinically, however, these infiltrations 
must be considered together, because the symptoms are 
the same, and there is little difference in the treatment. 
Submucous inflammation of the larynx, chondritis, 
perichondritis, etc., give rise to sero-purulent exuda- 
tions, which cause engorgements in different parts of 
the larynx, and produce symptoms which are identical 
with those which are caused by serous engorgement 
accompanying general disease, or diseases of parts con- 
tiguous to the affected larynx. While it may be pos- 
sible to treat sero-purulent infiltration with two gran- 
ules of iodoform and two of arseniate of soda three or 
four times daily, and with revulsives and topical appli- 



392 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

cations, the same is not true of serous infiltration, 
which is almost always caused by severe general dis- 
eases, which must be cured before the oedema will dis- 
appear. The pain is sometimes very severe, and may 
offer an obstacle to deglutition. This pain may be re- 
lieved by the use of two granules of Gregory's salt, 
cocaine, and hydrobromate of morphine every quarter 
of an hour until relief is obtained. The cough is not 
usually of great significance, but in cases in which it is 
very troublesome it may be soothed with two granules 
of Gregory's salt or two of the hydrobromate of mor- 
phine every quarter of an hour. The dyspnoea indi- 
cates revulsives and topical applications, and it may 
also be modified by the use of one granule of atropine 
with two of sulphate of strychnine every half-hour. 
When the dyspnoea becomes sufficiently urgent to 
threaten life, tracheotomy must be performed as a last 
resort. 

h5q ( a™.« ™„.,,7,«*4. { n «u m ^*» n (Iodoform, arseniate of 

<% ( Dominant. \ Sero-purulent infiltration . j sodc% re ' vlllsives . 

Treatment of the cause. 
Cocaine, morphine. 
Gregory's salt. 
Atropine. 
Tracheotomy. 



& <3 I ( Dropsical infiltration 

fctf\ fPain . 

§gW«« to. a 

^ [Asphyxia 



(Edema of the LungSo — See Pulmonary Conges- 
tion. 

(EsophagismuSo — Spasm of the oesophagus, or 
cesophagismus, is a dynamic affection, whether it be 
idiopathic or caused by lesions of distant parts, for ex- 
ample, uterine diseases, intestinal parasites, etc. The 
essential perturbation consists in an exaggerated con- 
tractility of the oesophagus, which may occur after the 
slightest irritation. The dominant indication consists, 
therefore, in hyoscyamine, atropine, or daturine, com- 
bined with the sulphate of strychnine, for the reason 
that there can be no spasm without paralysis. The 
antispasmodic alkaloids should be given every half- 



ELEMENTS OF DOSIMETRIC PRACTICE. 



393 



hour, in acute and recent cases, until the spasm is over- 
come. In chronic cases we should give only one gran- 
ule of one of the mydriatics, with two of the hypophos- 
phite or the sulphate of strychnine, four times daily. 
This condition, in the form of spasmodic dysphagia, is 
frequently a phenomenon of hysteria or some other of 
the different varieties of so-called nervousness. In the 
intervals between the attacks such cases should be 
treated with three granules of the bromide of camphor 
three times daily and cold baths. This form of spasm 
is not infrequently attributed to entozoa, and especially 
to taenia. In such cases the treatment would consist in 
the removal of the cause by the use of ten granules of 
santonine twice daily, or twenty to thirty centigrammes 
of pelletierine at one dose. Should the condition persist, 
in spite of these vermifuges, antispasmodic treatment 
should be adopted, the same as if the dysphagia were 
essential and not symptomatic. Insufficient alimenta- 
tion will result in more or less decided anaemia from in- 
anition. Such a result may be avoided by the use of the 
oesophageal catheter, which will not only be a medium 
for furnishing food, but will allay the spasm as well. 
Enemata of suitable peptones may also be used. If 
anaemia is actually present, it may be treated with two 
to three granules of the valerianate of iron at each 
meal. Hygienic measures directed to the moral nature, 
and regular exercise are indispensable auxiliaries in 
treatment. 



Dominant. 



Variant. 



Spasm 
Hysteria 
Nervousness 
Entozoa 

Anaamia 



Atropine, strychnine. 
Bromide of camphor. 
Hydrotherapy. 

Santonine, tannate of pelletierine. 
Salts of iron, artificial alimenta- 
tion. 



Oesophagitis. — Inflammation of the oesophageal 
mucous membrane may be acute or chronic. If acute, 
it may be primary or secondary. Primary oesophagitis 
is usually due to the irritant action of foreign bodies, 
poisonous substances, and too hot or too cold food. Sec- 



394: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

ondary oesophagitis is due to the extension of an in- 
flammation in neighboring organs, whether the pharynx, 
larynx, or stomach, or to the localization of an infec- 
tious disease, such as variola. Chronic oesophagitis 
results from the continuation of an acute oesophagitis, 
or from a venous stasis which is caused by lesions of 
the circulatory apparatus. The fundamental morbid 
elements are consequently inflammatory, atonic, or in- 
fectious, and are therefore to be treated with aconitine, 
strychnine, or the sulphide of calcium. The frequency 
of the doses will depend upon the severity of the dis- 
ease ; one granule may be given every two hours or 
every half-hour. Dysphagia, which varies in different 
cases in accordance with individual susceptibility, the 
nnmber of the existing lesions, and the severity of the 
ulcerations which may be present, depends more upon 
the sensibility of the mucous membrane to irritation, 
which is determined by antiperistaltic movements of 
contraction causing regurgitation of the contents of the 
alimentary canal, than upon contraction of the caliber 
of the oesophagus. The indication is, therefore, to use 
antispasmodics, say one granule of hyoscyamine or 
sulphate of atropine every half -hour, in order to allow 
liquid food, either soup or milk, to pass without regur- 
gitation. It is better to dissolve the granules in warm 
water, or in some mucilaginous substance if they con- 
tain an irritating substance, veratrine, for example. 
The pain which is also an obstacle to deglutition may be 
relieved by the use of two granules of the hydrobromate 
of morphine every quarter of an hour. The fever which 
accompanies the severer forms may be moderated by 
using one granule of aconitine every hour, and, if there 
are perceptible remissions or intermissions, three gran- 
ules of the hydrobromate of quinine may be given each 
hour during the intermission. The suppuration in 
the phlegmonous form of oesophagitis calls for the com- 
bined use of two granules of the arseniate of quinine 
and two of iodoform four times daily. For hsemor- 



I Dominant. 



\ Variant. 



ELEMENTS OF DOSIMETRIC PRACTICE. 395 

rhages, three granules of ergotine dissolved in water 
may be given every quarter-hour, or two of tannic acid 
at the same intervals. When the ulcerations begin to 
cicatrize, the formation of definite organic lesions is to 
be feared. This unfortunate result may be obviated 
to a certain degree by the use of two granules of iodo- 
form and two of arseniate of soda three times daily. 
The diet should consist of liquids, especially of luke- 
warm milk. In some cases rectal alimentation will be 
required, enemata of peptones being indicated. 

( Primary j ln ^ t m # ator3 [ de ; | Aconitine. 

{ fFrom extension of * -«_«♦_-.„ 

U „ 1 ™ J an inflammation [Aconitine. 

I ^ econaaI 7 1 F rom infection . Sulphide of calcium. 
[From venous stasis Digitaline, strychnine. 

( Dysphagia Hyoscyamine. 

t> .„ ( Hvdrobromateof mor- 

Pam j phine. 

Fever Aconitine. 

Suppuration .... j Iodoform, arseniate of 

1 L ( quinine. 

Hemorrhage .... Ergotine. 

I Sequelae j Iodoform, arseniate of 

Orchitis. — Orchitis is almost always caused by 
direct irritation or by transmission by continuity of 
tissues. Acute orchitis is usually recovered from spon- 
taneously in seven to fifteen days, unless injurious 
treatment is resorted to, or there is a want of care and 
attention to hygienic rules which are indispensable. 
In spite of the frequent resolution of acute inflamma- 
tion of the testicle, however, it sometimes passes into 
the chronic state, its cure thus becoming a more labori- 
ous process, and at others it may terminate by sup- 
puration, gangrene, or degeneration. But, even apart 
from such unfavorable terminations as those which 
were last mentioned, the disease is sufficiently severe 
and the time sufficiently long in which patients must 
lie in bed to prevent relapses, that one should seek 
to abridge it as much as possible, by the means which 
may be furnished by dosimetry. The aim should be, 



396 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

therefore, not only to diminish the duration of the dis- 
ease, but also the probabilities of a less favorable termi- 
nation than resolution. In acute orchitis we should 
combat the inflammatory element with aconitine from 
the beginning. The treatment should be the more 
active as the disease trenches the more upon the general 
condition. If there is fever with a strong, hard, and 
accelerated pulse, a granule of digitaline should be 
added to the aconitine, each being given every half-hour 
until a defervescent condition is established. If there 
is no febrile reaction, two granules of aconitine may be 
given four times daily, as an anticongestive. The pains, 
which are due largely to the unyielding character of 
the inflamed tissues, may be relieved with one granule 
of cicutine every hour, and if the pain has a spasmodic 
character a granule of hyoscyamine may be given every 
two hours with satisfactory results. The nausea and 
vomiting which sometimes accompany the first stage 
of the disease should be treated with one granule of 
hyoscyamine and three of the hydrochlorate of mor- 
phine every hour until relief is obtained. In the sub- 
acute and chronic conditions, two granules of the sul- 
phate of strychnine should be given four times daily 
to hasten the process of resolution. The local applica- 
tion of compresses saturated with cold water, in addi- 
tion to the internal treatment, will have an excellent 
antiphlogistic and tonic effect. The daily use of Sedlitz 
Chanteaud is indispensable to prevent the bad effect 
which may be produced by constipation or hsemor- 
rhoidal congestion. Suppuration calls for surgical in- 
terference, but one should not overlook the advantages 
which may also be obtained by the use of two granules 
of iodoform combined with two of the arseniate of iron, 
of soda, or of quinine, three or four times daily. Surgi- 
cal attendance will also be required if a case terminates 
in gangrene, and in addition one may give two granules 
of the salicylate of ammonia and two of salicylic acid 
four times daily. 



ELEMENTS OF DOSIMETRIC PRACTICE. 397 



m I Dominant. Inflammatory element 



H 



Pain 



g ( Spasm . 

q Variant. / Nausea, vomiting 

Dh I j Suppuration 

Gangrene 



Aconitine. 

Cicutine. 

Hyoscyamine. 

Morphine, hyoscyamine. 

Iodoform, arseniate of quinine. 
( Salicylate of ammonia. 
( Salicylic acid. 



Osteocopic Pains.— See Syphilis. 

Ovaritis, — Simple acute inflammation of the ovary 
has the same dominant which other diseases have 
which are characterized by this morbid process. Aco- 
nitine, in doses as frequent as the severity of the case 
demands, will therefore form the basis of treatment. 
Should ovaritis appear suddenly and inexplicably, 
especially in women who also present the phenomena 
of rheumatism, a granule of colchicine should be com- 
bined with one of aconitine, and be given every half- 
hour, or less frequently if the fever does not exceed 
38*5° C. The symptoms of ovaritis are almost always 
the same as those of metritis, and can only be differen- 
tiated from them by localization of the pain, which 
should be limited to one of the iliac regions in ovaritis, 
but may occupy the entire hypogastrium in metritis. 
These pains should be promptly relieved by using 
three granules of the hydrochlorate of morphine and 
one of hyoscyamine every half -hour. For the fever 
we should give aconitine, adding hydroferrocyanate of 
quinine if there are intermissions in the case. Nausea 
and vomiting will not only fatigue the patient, but 
will aggravate the abdominal trouble, and interfere 
with the regularity of the treatment. They may be 
treated with three granules of codeine every ten min- 
utes. Sedlitz Chanteaud should be used freely as an 
ordinary beverage, a soupspoonful being given in a 
glass of sweetened water which may be flavored with 
lemon or orange peel. Ovaritis which occurs during 
menstruation, and is especially apt to be associated 
with dysmenorrhea, is sometimes accompanied with 
severe haemorrhages. In such cases the treatment with 
aconitine should be supplemented by the haemostatic 



398 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

action of ergotine, three granules being given every 
quarter-hour. Contractions of the rectum and bladder 
will require the use of daturine in one-granule doses 
every half-hour. Should the ovary suppurate, two 
granules of iodoform with two of the arseniate of qui- 
nine should be given five times daily. If the ovaritis is 
not checked, it sometimes passes into the chronic condi- 
tion, for which the dominant is ergotine in two-gran- 
ule doses four times daily. The secondary indications 
will vary greatly, according as there is simple inflamma- 
tion or the development of cysts, and according to 
their volume, their position, their adhesions, etc. The 
most frequent indications are those which are here de- 
tailed. For constipation, which is almost always pres- 
ent, we should give three to five granules of podophyl- 
lin every evening, and in the morning half a spoonful 
of Sedlitz Chanteaud. The podophyllin may be alter- 
nated from day to day with veratrine in doses of three 
to five granules, or leptandrine, ten granules. To over- 
come the vesical tenesmus, daturine may be alternated 
with gelsemine. Enemata of very hot water (40° to 
45° C.) will usually be found very useful for this cause 
of dysuria. The dyspnoea may be relieved by the use 
of two granules of cicutine four times daily, or two of 
digitaline every three hours, until the pulse shows that 
a decided effect has been produced. Dyspepsia will 
require three granules of quassine before each meal, 
and three of pepsin after each. Should cedema be 
manifest, it will almost always be due to compression 
upon the veins by the enlarged or enlarging cyst, and 
should be treated with strychnine and digitaline, that 
the heart may have additional force to overcome the 
obstacles which oppose themselves to its propulsive en- 
ergy. The more voluminous cysts require ovariotomy, 
which becomes a necessity when the diagnosis is no 
longer doubtful. Every moment lost after that step 
has been reached tends to diminish the chances of suc- 
cess from the operation. As the cyst enlarges, the 



ELEMENTS OF DOSIMETRIC PRACTICE. 



399 



chances of success become more precarious on account 
of the injuries which result to the abdominal viscera 
from its presence. The author has seen atrophy of the 
large intestine to such a degree that it presented no 
more than a fifth of its normal volume, this result be- 
ing due to the pressure of a large ovarian cyst. When 
the lesions can be remedied by operative means alone, 
all delay is harmful, and sometimes even irreparable. 







OVARITIS. 






Acute. 


Dominant. 


I Simple 
[ Rheumatic 


• 


Aconitine. 

Aconitine, hyoscyamine. 




/ Pain 


. 


Morphine. 




Fever 




j Aconitine, hydroferrocyanate of 
" ( quinine. 
Codeine. 
Sedlitz Chanteaud. 








Variant. ( 


Nausea and vomiting 
Constipation . 




Metrorrhagia . 


, 


Ergotine. 




Tenesmus 


, 


Hyoscyamine. 




\ Suppuration . 


• 


Iodoform, arseniate of quinine. 






Chronic. 


Dominant. 


Hypertrophy . 




Ergotine. 




/ Constipation . 




j Podophyllin, leptandrine, vera- 
* l trine. 




Vesical tenesmus 




Daturine. 


Variant. / 


Dyspnoea . 




Cicutine. 




Dyspepsia 




Quassine, pepsin. 




(Edema . 




Strychnine, digitaline. 




\ Enlarged cyst . 




Ovariotomy. 



Ozsena. — See Rhinitis. 
Palpitations of the Heart. 



See Hyperkine- 



sis. 



Pancreatitis. — The diseases of the pancreas, which 
as yet have not been thoroughly investigated, are 
almost always consecutive to other morbid conditions, 
and rarely require particular treatment. The symptoms 
which are suggestive of pancreatitis are pain of a more 
or less constant character in the region of the umbili- 
cus and the epigastrium, which should be treated with 
three granules of codeine or morphine three times 
daily ; liquid stools which look like saliva, which would 
probably be modified by the use of one granule of atro- 



400 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

pine every two or three hours ; and dyspepsia, espe- 
cially after the use of hydrocarbonaceous food, for 
which three granules of diastase may be given after 
each meal. 

PANCREATITIS. 

Dominant Treatment of the primary disease. 

( Pain Codeine, morphine. 

Variant. < Serous diarrhoea . . Atropine. 

( Dyspepsia .... Diastase. 

Parotitis (Parotiditis).— Inflammation of the pa- 
rotid glands may be idiopathic or a complication 
in many of the infectious diseases, and in the latter 
case appears to be caused by elimination of the delete- 
rious products formed by the virulent agents. When 
it is idiopathic it is not usually a condition of grave im- 
portance. The predominant symptoms are those of any 
other condition of fluxion, the volume of the inflamma- 
tory products being governed by the intensity of the 
process of serous transudation. One granule of aconi- 
tine, combined if necessary with one of the sulphate 
of strychnine, every two hours, or more frequently if 
fever is present, will quickly relieve the difficulty in 
the circulation. Parotiditis which follows infection of 
the organism requires the sulphide of calcium if the 
disease appears in the first stage of the infection, or the 
nitrate of pilocarpine if it occurs during the period of 
elimination. The dose of each should be two granules 
every hour. The pain is not intense in all cases. In 
those cases in which it is intense, two granules of the 
tannate of cannabine may be given every hour, or one 
of hyoscyamine every two hours. The disordered con- 
dition of the digestive function should be treated with 
appropriate doses of Sedlitz Chanteaud. Dyspnoea 
and delirium, which are usually caused by compression 
of the vessels of the parotid glands, indicate disgorge- 
ment by means of leeches, or the use of two granules of 
colchicine every two hours until purgation results. 
The suppuration may be diminished by the use of two 



ELEMENTS OF DOSIMETRIC PRACTICE. 



401 



granules of iodoform and two of the arseniate of qui- 
nine four times daily. The accumulations of serum 
which take place in other organs may be treated with 
five granules of the nitrate of pilocarpine every quarter- 
hour, or two of colchicine every hour. 



Dominant -i Inflammat0I T element 
' ( Infectious element 

Fever . 

Pain 

Gastric disorders 
Variant. ( Dyspnoea 

Delirium 

Suppuration 

Serous fluxion 



Aconitine. 

Sulphide of calcium. 

Aconitine. 

Tannate of cannabine. 

Sedlitz Chanteaud. 

Colchicine. 

Leeches. 

Iodoform, arseniate of quinine. 

Nitrate of pilocarpine. 



Pericarditis and Endocarditis. — Pericarditis 
may be primary or secondary. The former is much the 
rarer, and yet may be the more easily recognized from 
the beginning ; the course of the latter is insidious for 
a longer or shorter period of time, and, when at length 
the condition is evident from the subjective symptoms, 
it is too late to completely repair the damage which 
has been done. Hence, the evident duty of the physi- 
cian is to seek carefully for inflammation of the peri- 
cardium in all cases in which it is likely to be present, 
and to be always on his guard for its appearance. 
The inflammatory element of the disease in its acute 
form should be met with aconitine ; and the more re- 
cent the disease, and the more pronounced its symp- 
toms of excitation, the more active should the treat- 
ment be. In the chronic form of the disease aconitine 
should not be used, especially if the contractile force 
of the heart is diminished. In such a case the inflam- 
matory element is supplanted by the paralytic, and 
aconitine should therefore be replaced by two granules 
of the arseniate or the hypophosphite of strychnine four 
to six times daily. With respect to the variant, the fever 
must be vigorously met by the use of digitaline com- 
bined with aconitine and strychnine, one granule of 
each being given every half-hour or less frequently, 
according to the condition of the pulse and the eleva- 

26 



402 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

tion of the temperature. The combination of defer- 
vescents in the treatment of acute diseases of the heart 
should be managed with great prudence. The effect 
which is obtained will not be the total effect of the 
synergic agents, but there will be as many effects as 
there are agents employed. These agents must, there- 
fore, be so administered as to exercise a regulating 
action upon each one of the organs or systems upon 
which this action is particularly directed. Thus the 
quality and the number of the pulsations must govern 
the administration of digitaline, the temperature must 
govern the use of aconitine, the contractility that of 
strychnine ; consequently the three defervescents must 
not be associated imprudently, and they must be given 
only as each has its particular indication. This advice, 
which is important in all antiphlogistic treatment by 
means of defervescents, is of particular importance in 
the treatment of acute diseases of the heart. If the 
thoracic pain is severe, it may be relieved by the use of 
two granules of cicutine every half -hour. Should the 
pulse become vibratile and very full, the cardiac ex- 
citability may be diminished by the use of two gran- 
ules of digitaline three or four times daily ; the danger 
of a corresponding depression after this treatment must 
be borne in mind. If the pulse is very feeble, sulphate 
of strychnine is urgently indicated, or caffeine, two 
granules of either being given every half-hour. Dys- 
phagia, which is an important sign, not only as an in- 
dicator of the presence of the disease, but also as an 
evidence of spasmodic irritation of the vagus, should 
be treated with one granule of hyoscyamine every two 
hours. Insomnia, which will quickly reduce the 
strength and contribute to cardiac ataxia, should be 
treated with three granules of the hydrobromate of 
morphine every quarter of an hour, or similar doses of 
croton chloral. Dyspnoea may come from several 
causes, but is almost always due to more or less pro- 
nounced systolic weakness, and should be treated with 



ELEMENTS OF DOSIMETRIC PRACTICE. 



403 



two granules of apomorphine and two of caffeine every 
half-hour. Excellent results may also be obtained from 
the use of digitaline with the other remedies. Hic- 
cough, which is very annoying, and which also inter- 
feres with the regularity of the circulation, should be 
treated with one granule of atropine every hour. In- 
stead of the alkaloid atropine, one of its salts may be 
used. Dropsy of the limbs and of the viscera requires, 
above all things, the heart- tonics digitaline, caffeine, 
and strychnine, and diuretics scillitine and Sedlitz 
Chanteaud. Two to three granules of the scillitine may 
be given three times daily, and of the Sedlitz a small 
spoonful in the morning. Simple endocarditis requires 
the same treatment as pericarditis. The principal in- 
dications and means of treatment are common to the 
two diseases. In chronic endocarditis, however, the 
nutrition of the heart should be modified by the use of 
two granules of the arseniate of soda and two of the 
arseniate of antimony three times daily. Infectious 
endocarditis is extremely dangerous, and a tonic treat- 
ment alone is appropriate. Two granules of salicylate 
of ammonia and two of iodoform, combined with two 
of arseniate of strychnine every hour, may be given with 
suitable defervescents if the temperature is elevated. 
In spite of the most judicious treatment patients with 
this disease rarely recover. 

Inflammatory element . 



/ Dominant. 



\ Variant. 



/ Fever . 
Thoracic pain 
Fullness of pulse . 

Weakness of pulse 

Dysphagia . 
Insomnia 
i Dyspnoea 
Hiccough 

Dropsy . 
Adynamia . 
Hyperplasia . 



( Aconitine, arseniate of strych- 
] nine. 

Digitaline. 

Cicutine. 

Digitaline. 
( Sulphate of strychnine. 
] Caffeine. 

Hyoscyamine. 

Hydrobromate of morphine, 

Apomorphine, caffeine. 

Atropine. 
( Caffeine, digitaline, strychnine. 
\ Sedlitz Chanteaud, sciilitine. 
( Salicylate of ammonia. 
< Iodoform, arseniate of strych- 
( nine. 

j Arseniates of soda and anti- 
{ mony. 



404 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Peritonitis. — Peritonitis may occur as a simple in- 
flammatory process, as an accompaniment of general or 
local infection, and as a consequence of such dyspa- 
sias as the tuberculous, the cancerous, as an accom- 
paniment of Bright' s disease, etc. The dominant will 
vary with the determining causes ; if the disease is a 
simple inflammation, aconitine will be required ; if due 
to infection or the dyscrasias, it will require the treat- 
ment of the disease which is the exciting cause. Pri- 
mary peritonitis manifests itself in a positive and un- 
mistakable manner. The patient is seized with violent 
chills, with intense fever, and with severe pain in the 
abdomen. At the commencement of the chill one 
should give one granule of the sulphate of strychnine 
and one of phosphoric acid every quarter of an hour 
until reaction occurs. After reaction has been estab- 
lished the fever will be high, and there must be rapid 
interference in order to check it ; we should therefore 
give one granule each of the defervescents aconitine, 
digitaline, and veratrine every quarter of an hour, and 
two of the hydroferrocyanate of quinine every half- 
hour, adding every hour one granule of strychnine to 
overcome the vasomotor paralysis. The pain is always 
extremely severe, and this is a symptomatic indication 
which must never be neglected, for it not only tends to 
aggravate the inflammatory condition, but also to de- 
prive the patient of the strength which is so necessary 
to enable him to undergo the difficulties which threaten 
him. The abdominal pain, therefore, should be treated 
with two granules each of the tannate of cannabine and 
two of the hydrobromate or the hydrochlorate of mor- 
phine every quarter-hour. Meteorism, which is caused 
by the distention of the paralyzed intestine with gas 
which has been generated therein, should be treated 
with two granules of ergotine every half -hour, or with 
larger doses of strychnine. Constipation is also a re- 
sult of intestinal paralysis ; or there may be diarrhoea, 
as a result not only of atony of the sphincter, but of 



ELEMENTS OF DOSIMETRIC PRACTICE. 405 

hypersecretion from the irritation resulting from flux- 
ion pertaining to the mucous membrane. Both consti- 
pation and meteorism should be treated with Sedlitz 
Chanteaud and strychnine given simultaneously. If 
diarrhoea is present, there is no need of taking active 
steps to check it until the disease itself is checked, 
unless there is evidence that the patient is being ex- 
hausted by it, in which case the doses of morphine must 
be sufficient to check hypersecretion. Vomiting, which 
is a reflex effect produced by irritation of the nerves in 
the region which is involved, may be controlled by the 
use of two granules of morphine and one each of hyos- 
cyamine and strychnine every half-hour. Hiccough, 
which is due to irritation of the diaphragm, the in- 
fluence being transmitted from the inflamed peritoneum 
which covers the lower surface of that muscle, may be 
arrested by the use of one granule of hyoscyamine every 
half -hour. Such a result is obtained with the greater 
difficulty in cases in which the increase of abdominal 
pressure embarrasses the respiration and the circula- 
tion. The principal indication is to produce a tonic 
action upon the vagus nerve, which presides over the 
principal thoracico-abdominal functions, and this may 
be best effected by using two granules of strychnine 
every half-hour. The strychnine will have the addi- 
tional advantage of opposing paralysis of the diaphragm, 
which may be excited by inflammation of its serous 
membrane. Chronic peritonitis, which is usually of a 
tuberculous character, should be treated with vesicants 
locally, and the persistent use of iodoform, the arseni- 
ates of iron and of soda, or the arseniate of quinine. 
Two granules of each should be given three to five 
times daily. The disease becomes more severe with 
each succeeding attack. During the acute phase of 
the attack, defervescent agents should be actively 
used, but only with the view of retarding the prog- 
ress of the disease, which must inevitably have a fatal 
issue. 



406 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



{Inflammatory element 
Dyscrasic and infectious 
elements . 



Chills 



Fever 



Pain 



/ Meteorism . 
\ Variant. ^ Constipation 

Diarrhoea 



Vomiting 



Hiccough 
Cardio-pulmonary 
plications . 



Chronic peritoniti 



Aconitine. 

Treatment of the primary dis- 
ease. 

Sulphate of strychnine, phos- 
phoric acid. 

Aconitine, digitaline, veratrine. 

Hydroferrocyanate of quinine. 

Sulphate of strychnine. 

Hydrobromate of morphine. 

Tannate of cannabine. 

Ergotine, sulphate of strych- 
nine. 

Sedlitz Chanteaud. 

Hydrochlorate of morphine. 

Hydrochlorate of morphine. 

Hyoscyamine, sulphate of 
strychnine. 

Hyoscyamine. 

Arseniate of strychnine. 
Iodoform, arseniates, revul- 



Phthisis. — See Tuberculous Disease. 

Plethora. — If the sanguiue disposition is becoming 
less and less common both, in the city and in the coun- 
try, the plethoric condition is becoming still less com- 
mon. Plethora is in reality only an exaggeration of 
the sanguine temperament. Just as the nervous diath- 
esis is only an exaggeration of the nervous tempera- 
ment, and the lymphatic diathesis an exaggeration of 
the lymphatic temperament, so plethora is an advanced 
stage of the sanguine temperament. It can not be said 
that it is a true morbid state, nor yet that it is an ex- 
cessive degree of health, but it is a condition of health 
in which disease may be said to be imminent. An ex- 
tremely plastic condition of the blood, its richness in 
red globules — conditions which are disproportionate to 
the wants of organic nutrition — these constitute pleth- 
ora. The manifest indications are to increase the con- 
ditions of elimination and diminish the ingestion of 
assimilable material. Aside from the proper modifica- 
tions as to regimen and exercise, the refreshing influ- 
ence of Sedlitz Chanteaud should be obtained, and the 
work of the circulation should be modified by the in- 
fluence of two granules of aconitine and two of digita- 



ELEMENTS OF DOSIMETRIC PRACTICE. 407 

line morning and evening. When there is a tendency 
to congestion of the head, which is indicated by som- 
nolence, injection of the conjunctivae, redness of the face, 
rumbling in the ears, etc., a granule of the citrate of 
caffeine should be given every half-hour, and one or 
two doses of aconitine and digitaline. The disposition 
to hyperemia of the lungs, which is manifested by op- 
pression in breathing, palpitations, etc., may be treated 
with two granules each of aconitine, veratrine, and 
digitaline three times daily. After hyperemia is estab- 
lished, a few leeches may be used upon the affected 
parts, after which anticongestive means may be used 
until the pulse is softer in character, and the danger 
of congestion in the more important viscera is past. 

PLETHORA. 

t-v j Suitable diet, Sedlitz Chanteaud, 

( aconitine. 

Variant \ Cephalic hyperemia . Citrate of caffeine. 

' ( Thoracic hyperemia . Digitaline, veratrine. 

Pleuritis. — Pleuritis may proceed either from ex- 
ternal or internal causes. Pleuritis of internal origin 
may proceed from a general disease, such as rheuma- 
tism, albuminuria, the eruptive fevers, and infectious 
diseases, from lesions of tissues contiguous to the 
pleura, the inflammatory process extending to the lat- 
ter, or from injury to the latter from the development 
of morbid products. Pleuritis of external origin may 
result from traumatism or from the effect of cold, with 
or without the suppression of the perspiration. The 
disease may be acute or chronic. The latter variety 
may have the characteristics of a chronic disease from 
the beginning, or it may follow the acute form. In- 
flammation of the pleura, with reference to the quan- 
tity and nature of its exudates, may be considered 
clinically under two forms — the proliferative, or dry, 
and the exudative, or effusive. The first may be con- 
sidered an abortive form of the second. From pro- 
liferative pleuritis to purulent pleuritis there is a 



408 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

series of morbid transformations which succeed each 
other in natural order, and are like the successive 
steps in a plan which is in process of evolution. As 
the last of these steps is one which indicates a great 
degree of gravity, we should spare no efforts to break 
the series and check the disease at the beginning, so as 
to avoid the consequences, as grave as they must be, 
which are likely to follow when an expectant plan of 
treatment is carried out. In the first phase of the dis- 
ease, whatever be its primary form, we should not lose 
an instant in endeavoring to accomplish its control. 
Statistics show that pleuritis is fatal in a larger per- 
centage of cases than it used to be, and this can be 
accounted for only by the injurious effects of the ex- 
pectant plan of treatment. The physicians of the dosi- 
metric school in its earlier periods, notwithstanding 
the imperfection of their methods for checking this 
disease, had better success, and their results were 
more satisfactory than those which were obtained by 
the followers of actual science. The latter were armed 
with means for treating the disease during its last 
period, but were unable to do anything when the dis- 
ease was still without threatening features, when the 
lesions were such that they could be repaired, and when 
a restoration from a pathological to a physiological 
condition could easily be accomplished. Therapeutics 
should always aim to be preventive, and not be limited 
merely to the prevention of death, but, on the contrary, 
it should prevent the phenomena which lead to it. 
When a patient with pleuritis summons a physician in 
the earliest stages of his disease, and, notwithstanding, 
presents the symptoms of purulent pleuritis after a cer- 
tain length of time, it can be almost affirmed that his 
unfortunate condition is due to the negligence of his 
physician. If the physician will use defervescent 
agents in a methodical manner, he will not be compelled 
to resort to trocars and aspirators, and it should always 
be his aim to avoid the latter means. The statistics of 



ELEMENTS OF DOSIMETRIC PRACTICE. 409 

actual science ought not to be somber ; it should not 
boast of its progress while compelled to blush at its 
clinical results. The dominant in acute dry pleuritis 
is that which is common to all inflammatory affections. 
But in this case aconitine must not only be used as a 
febrifuge ; it must also be used as an anticongestive. 
The elements of inflammation must be attacked vigor- 
ously — congestion with aconitine and digitaline, vaso- 
motor paralysis with strychnine — and this treatment 
must be continued not only until the fever has ceased, 
but as long as the organism will tolerate it. One granule 
of each may be given every fifteen minutes, or at longer 
intervals if such is the indication. Vesicants and blood- 
letting are absolutely contra-indicated, the former be- 
cause they increase the existing pain and add an in- 
flammation to one which is already present, the latter 
because it weakens the patient too much and leaves 
him in a bad condition for undergoing the resorption 
of the exudates which have already been formed. 
Bloodletting is useful only at the time of invasion of 
the inflammatory state, but one is seldom called to see 
a patient at that time. On the other hand, leeches and 
wet cups may be very serviceable in making the in- 
ternal antiphlogistic treatment more effective. Pleuritic 
pain, or costalgia, should be promptly treated with 
hypodermic injections of the hydrochlorate of mor- 
phine, or by the application of leeches. Internally, 
we may combine with the defervescent agents one or 
two granules of cicutine, or its hydrobromate, every 
half-hour until the pain is relieved. It must not be 
forgotten that pain is both a cause and an effect of in- 
flammation. Dyspnoea may follow violent pain and 
fever, and if these two elements are brought under con- 
trol the dyspnoea will cease with its causes. If special 
treatment for it were indicated, we should give aspidosa- 
mine or picrotoxine. In chronic proliferative pleuritis, 
chronic anticongestive means of treatment must be em- 
ployed, two granules of aconitine and two of arseniate 



410 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



of strychnine being nsed three times daily. This form 
usually results from some complicating element, and 
we may be compelled not infrequently to give two 
granules of the arseniate of iron and two of iodoform 
three or four times daily as modifiers of the newly 
formed tissues which result from the disease. Kevul- 
sives upon the skin are also appropriate for this con- 
dition — for example, tincture of iodine, iodized cotton, 
and the actual cautery, their action upon the vital 
forces being both a general and a local one. The 
thoracic pains which frequently accompany this form 
of the disease may be relieved with two granules of 
cicutine three or four times daily. At the end of the 
proliferative period we find an effusion in the form of 
a fibro-serous exudate. The exudative period is not of 
long duration, because the pleura rapidly absorbs the 
material which is deposited upon its surface. If absorp- 
tion does not go on rapidly, the exuding process being 
more intense than the absorptive one, or if absorption 
is interrupted by the formation of false membranes 
which are interposed between the absorbing vessels and 
the exuded material, the volume of the latter may be- 
come quite large. In the former case, the pleuritis re- 
mains acute, the dominant being the same as in dry pleu- 
risy. The fever frequently assumes an intermittent type, 
and one of the salts of quinine becomes indispensable. 
Either the hydroferrocyanate, the hydrobromate, or 
the sulphate may be given in three-granule doses every 
three hours. The cough, which tends to increase the 
inflammation, should be treated perseveringly with two 
granules of the hydrobromate of morphine every twenty 
minutes ; or three-granule doses of codeine, Gregory's 
salt, or narceine may be given at the same intervals. 
Dyspnoea may result partly from fever and partly from 
compression. In the latter case, the indication is to 
exert a tonic action upon the lungs, that they may be 
the better enabled to accomplish their function and 
resist the pressure which is caused by the effusion. 



ELEMENTS OF DOSIMETRIC PRACTICE. 411 

Agents for accomplishing this purpose are apomorphine, 
hypophosphite of strychnine, and brucine, one to three 
grannies being given every two honrs. The exudate in 
chronic pleuritis may be fibro-serous, or it may be pu- 
rulent. If the effusion is serous, absorx^tion may be 
prevented by an atonic condition of the vessels of the 
pleura. The circulation of the respiratory apparatus 
should therefore be modified with picrotoxine, and the 
pneumogastric be incited to action by strychnine and 
apomorphine. Strychnine may be given in two- or 
three-granule doses every two hours until the face is 
somewhat congested. Apomorphine may be given in 
two-granule doses, with like quantities of caffeine, arbu- 
tine, and adonidine, four to six times daily, for their 
tonic and diuretic effects. The intermittent fever, which 
is not uncommon in chronic pleuritis with effusion, may 
be treated with three granules of the arseniate of quinine 
four times daily, or twenty granules of the salicylate of 
quinine twice daily. If the effusion is very abundant, 
dyspnoea and displacement of the heart demand surgi- 
cal interference. Thoracentesis should be performed 
only in cases in which the effusion is considerable and 
threatens life. The evidences of this effusion are com- 
plete silence upon auscultation, dullness on percussion 
over all or nearly all the anterior aspect of the thorax, 
the absence of vocal vibrations, and a feeling of fullness, 
which is evident to palpation, in the intercostal spaces. 
The indications for the operation and the steps which 
are to be taken are well described in "Clinique thera- 
peutique " of Dujardin-Beaumetz. If after the first 
thoracentesis neither the thoracic walls nor the pulmo- 
nary tissues return to their original position, it will be 
useless to repeat the operation, and a fatal issue will be 
hastened by the loss of strength which the operation 
necessitates. Thoracentesis should be preceded and 
followed by the liberal use of the incitants apomorphine 
and strychnine, so as to assist the pulmonary tissue 
in overcoming the inertia and want of expansibility 



412 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

which result from prolonged compression. Pleuritis 
with purulent effusion is accompanied by hectic fever, 
anorexia, sweating, etc. Before resorting to an opera- 
tion, which is about the only thing which can be done, 
as a last resort, the activity of the digestive function 
should be stimulated by using three granules of quas- 
sine three times daily ; and preventing purulent infec- 
tion by giving five granules of the salicylate of quinine 
and two of aconitine twice daily. After the operation, 
two granules of iodoform, with one of arseniate of iron 
and one of arseniate of strychnine, should be given 
twice daily, to arrest pyogenesis. If the acute pleuritis 
is diaphragmatic, the functions of the phrenic nerve 
may be interfered with, and a particular line of treat- 
ment required. Sedatives should be used freely with 
defervescents and antispasmodics, three granules of 
veratrine being given every half -hour until vomiting or 
contro-stimulation is produced ; also, one granule of 
hyoscyamine every two hours until a decided mydriatic 
effect is obtained. The cause of the pleuritis may also 
indicate a particular variant in its treatment. Thus, 
the treatment of pleuritis which is caused by cold 
should be six granules of the nitrate of pilocarpine 
every quarter-hour, or, if given hypodermically, twenty 
granules in a gramme of distilled water. Rheumatic 
pleuritis calls for the particular effect of colchicine. 
Pleuritis which is due to albuminuria, tuberculosis, or 
the eruptive fevers, should be treated mainly with in- 
testinal and cutaneous derivatives, and by the treat- 
ment of the cause. 



ELEMENTS OF DOSIMETRIC PRACTICE. 



413 



DOSIMETRIC TREATMENT OF PLEURITIS. 
Dominant. 

Inflammatory Cement | SnTpt^of^nnL. 

Variant. 
A. With Reference to the Nature of the Exudation. 



Proliferative 
or dry pleu- 
ritis . 



aS / Hyperthermia 

"3 J Dyspnoea 

^ ( Costalgia 
■g j Thoracic pains . 
2 I Lymphatic diathesis 



\o 



I 2 



/ Fever . 



( Continued 



Pleuritis 
with effu- 
sion . 



Cough 



Dyspnoea 



\ Costalgia 



Aconitine. 
Aspidosamine. 
j Hydrobromate of cicu- 
( tine. 

Cicutine. 
j Arseniate of iron, iodo- 
\ form. 
Aconitine. 

. \ ( Hydroferrocyanate, sul- 

( Intermittent ■< phate, or hydrobro- 
( mate of quinine. 
\ Morphine, narceine, co- 
' I deine. 
( Fever . . Aconitine, veratrine. 
. < C Apomorphine, hypo- 

( Compression -j phosphite of strych- 
( nine. 
Cicutine. 
Thoracentesis, diuretics. 






Fibro-serous 
effusion . 

branes 

Purulent uf- (£££» 
fusion . | Sweating 



Suffocation 

Intermittent ( Arseniate or salicylate 

fever . } of quinine. 
Pseudo-mem- J picrotoxine> 

Surgical means. 
Quassine. 

Atropine. 



B. 



With Reference to Situation. 

Veratrine. 

matic pteHS™ * ' ^ or ? hine - 

litis I Dyspnoea Cicutine. 

' [ Hiccough Hyoscyamine. 



"nio-r.i-.vorr f Contractures 

" Mental disturbance 



C. With Reference to Causation. 

Pleuritis from cold Nitrate of pilocarpine. 

Rheumatic pleuritis Colchicine. 

Infectious pleuritis Sulphide of calcium. 

Diathetic pleuritis (Derivatives, anticausa- 

r ( tives. 

Pleurodynia.— See Rheumatism. 

Pneumonia. — The dominant in pneumonia must 
conform to the pathogenic idea which we have concern- 
ing the disease. To most pathologists pneumonia 
means only a simple inflammation ; to others it is an 
infectious disease, the result of a poisoning of the or- 



414: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

ganism by a specific agent, discovered by Friedland- 
er, and named by him pneumococcus. Under the first 
hypothesis, the inflammatory element demands aconi- 
tine ; nnder the second, the infectious element compels 
us to use the parasiticide par excellence, sulphide of 
calcium. Pneumonia is the type of inflammations, not 
only on account of the intensity of the inflammatory 
process and the extensive area of tissue attacked, but 
especially on account of the vascularity of the pulmo- 
nary tissue. All the therapeutical considerations to 
which Burggraeve was the first to call attention as re- 
sulting from experimental physiology are applicable 
to pneumonia. Thus, in the first phase of the inflam- 
mation, the phase of vaso-motor paralysis, the arseni- 
ate of strychnine and phosphoric acid are especially 
indicated ; unfortunately, however, this phase has usu- 
ally been passed when the physician is called, the in- 
flammation is already established, and the treatment 
required is entirely different. Aconitine, the antihy- 
persemic medicament par excellence, gives, in inflam- 
matory conditions, results which are the more excellent 
as the organs attacked are the more vascular. But, 
though the effect of the drug is rapidly produced, the 
congestion reproduces itself with equal facility. For 
this reason we should not only combine the defervescent 
remedies in our plan of treatment, but we should con- 
tinue their use in gradually decreasing doses, and 
fix their effect by means of the neurosthenic agents 
brucine and strychnine. The immediate relation which 
exists between the pulmonary circulation and the heart 
compels us to consult the state of the pulse in order to 
insist upon one or another of the defervescents, accord- 
ing to the nature of the predominant symptoms. Thus, 
when the pulse is large, strong, and of good tension, 
two granules of veratrine should be given every quarter- 
hour ; if the pulse is very frequent, a granule of 
digitaline should be given every half-hour until the 
number of pulsations is lessened. If the heart-force 



ELEMENTS OF DOSIMETRIC PRACTICE. 415 

seems to be diminishing, one to two grannies of strych- 
nine may be given every half-hour. The nse of aconi- 
tine, on the other hand, must be regulated by the 
thermometer ; one granule may be given every quarter- 
hour if the temperature exceeds 39 '5° C, every half- 
hour if it is 39° C. or under. If the infectious nature 
of pneumonia is assumed, and there are numerous and 
excellent reasons for such an hypothesis, one granule 
of the sulphide of calcium may be given every quarter- 
hour. This agent is very efficient as a defervescent ; 
its elimination by the bronchial mucous membrane fa- 
vors solution of the exudate which results from the dis- 
ease, thus making it an excellent expectorant, and as a 
diaphoretic it corresponds to the causal indication. 
In no case can the sulphide of calcium do harm, what- 
ever be the conception of the jDathogenesis of the disease. 
Among the indications of the variant that which is most 
noticeable is a decided chill, if we are called at the be- 
ginning of the disease. To meet this symptom one gran- 
ule of sulphate of strychnine combined with one of phos- 
phoric acid should be given every quarter of an hour 
until reaction occurs. The pain in the side, which may 
be regarded as an intercostal neuritis, should be treated 
persistently with three granules of hydrobromate of 
morphine every quarter of an hour. The violence of 
the pain tends greatly to increase the dyspnoea, the 
pulmonary congestion, and the circulatory disturbance 
in general. Should the physiological effects of the 
morphine be apparent before its therapeutic effects, 
and compel us to suspend its use before its beneficial 
effects have been realized, it may be replaced by two to 
four granules of the tannate of cannabine every quarter- 
hour, or two of cicutine every half -hour. In the early 
stage of pneumonia, wet cups may be used with advan- 
tage. The dyspnoea, which is caused not only by pain, 
fever, hypersemia, and diminution of the area of the re- 
spiratory field (which also diminishes the coefficient of 
oxygen for the red corpuscles), but also by troubles in 



416 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

the heart-action, must be treated with digitaline to regu- 
late and strengthen the heart-muscle, in addition to 
aconitine and morphine, which respond to other indi- 
cations. The cough, which assumes different charac- 
ters in different stages of the disease, should be treated, 
during the fever, with Gregory's salt or iodoform, and 
codeine, two granules of each being given every quarter- 
hour until this symptom is relieved. If the cough is 
caused by difficulty in expectorating the inflammatory 
accumulation, we should give two or three granules of 
scillitine, emetine, or arseniate of antimony every two 
hours ; or one of emetic every two or three hours, alone 
or combined with two of codeine, in case there is gastro- 
intestinal intolerance. Emetic and emetine can rarely 
be given to children, especially to nursing children. 
Their action is too depressing for very sensitive or- 
ganisms, and this statement applies equally in cases in 
which they excite vomiting, and in cases in which they 
do not. If there seems to be a necessity to resort to 
their use, they should be given in very small quanti- 
ties, combined with brucine or caffeine, which will in- 
crease the expectorant action and diminish the depress- 
ing effect. Emetine may be replaced by scillitine, 
kermes mineral, or lobeline, one granule being given 
every two hours. Bromide of camphor and helenine 
are also excellent expectorants, and may be used with- 
out danger, two granules of either being given three to 
live times daily. If there is adynamia, or fear that it 
may supervene, the hypophosphite of strychnine should 
be given without apprehension. It should be given in 
doses of two or three granules every hour until the 
pulse recovers its normal vigor. Such treatment is 
especially applicable in the pneumonia of the aged, and 
it has been successfully treated by the author by this 
method in all cases in which it has been seen sufficiently 
early. Success with any method of treatment is always 
the best guarantee of its efficiency. In all cases, how- 
ever, the greatest vigilance is indispensable ; all possi- 



ELEMENTS OF DOSIMETRIC PRACTICE. 417 

ble hypotheses must occur to the mind, and all must 
be carefully analyzed, in order that each exigency may 
be met as soon as it occurs. It must also be remem- 
bered that pneumonia may exist in the aged for several 
days before any outward symptom presents itself. The 
cough in such cases may be insignificant or without 
positive characteristics ; there may be neither dyspnoea, 
anorexia, pain in the side, nor fever. The thorax must 
be carefully auscultated for its physical signs. A con- 
dition which is often attributed by the aged to consti- 
pation may be pneumonia, the grave character of which 
becomes manifest only when adynamia has generalized 
its symptoms. The hypophosphite of strychnine, regu- 
larly given night and day, generous wine, and a nour- 
ishing diet, may cure this disease, which is usually 
considered of grave import, because one always defers 
intervention until it has become incurable. As an ex- 
pectorant and anticongestive, two granules of bryonine 
or two of apomorphine may be given every two hours 
with good results. Should expectoration continue to 
be difficult, and asphyxia be threatened from obstruc- 
tion of the bronchi, emetic may be given, preceded, 
however, by strychnine, as in this way the dangers 
which usually attend its use during the adynamic 
period may be avoided. Mild delirium, which is symp- 
tomatic of cerebral anaemia, may be treated with two 
granules of caffeine every half-hour, or with similar 
doses of bromide of camphor. This symptom is not 
of particular importance, and calls only for a suitable 
reparative diet. Active delirium, which is of frequent 
occurrence among alcoholic subjects, is due to a want 
of cerebral stimulation. To restore the equilibrium, 
port or madeira wine diluted with water, so that an 
existing gastro-intestinal catarrh may not be aggra- 
vated, should be administered, or one granule of hyos- 
cy amine every two hours. Icterus, which is due to 
catarrh of the biliary ducts, from extension of the gas- 
tro- duodenal inflammation, or from irritation produced 
27 



418 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

by localization of the infection of the liver, calls for 
two granules of colchicine every two hours if the first 
of these two conditions obtains, or two granules of calo- 
mel every two hours until the dejections have regained 
their normal dark color. Gastro-intestinal catarrh, and 
the necessity of facilitating the elimination of the pneu- 
mococcus, require the use of Sedlitz Chanteaud, the 
dosage to be regulated by the conditions of each case. 
When asphyxia announces an approaching fatal ter- 
mination from vital depression, oedema, or pulmonary 
stasis, large blisters should be used, and the hypophos- 
phite of strychnine, as has already been indicated. It 
is only in such a condition that vesicants are useful, 
their function being to excite vaso-motor contractility, 
and to diminish the obstruction to the pulmonary cir- 
culation. If the disease follows its regular course, 
vesicants are not only useless, but they increase the 
suffering of the patient, expose him to the risk of tak- 
ing cold, aggravate the causes of dyspnoea, and con- 
tribute notably to the appearance of albuminuria. 
Should pneumonia terminate in abscess, three gran- 
ules of iodoform and two of arseniate of soda may 
be used every four hours. During convalescence the 
reparative forces should be stimulated by means of 
quassine to increase the appetite, and brucine to 
strengthen the lungs, two granules of each being 
given before meals ; two granules of arseniate of 
iron should also be given with each meal to supply 
the red globules with iron. The ordinary classical 
treatment of pneumonia does not deserve the confi- 
dence of the physician, bleeding, emetics, etc., being 
condemned by statistics. The expectant plan is the 
one upon which physicians of the official school 
rely, while they prefer to do nothing and await a 
favorable turn of the disease. Let us leave them 
to their blindness and impenitence, and do our duty 
by employing our certain, effective, and harmless 
methods. 



ELEMENTS OF DOSIMETRIC PRACTICE. 



419 



{Infectious element 
Pneuraococcus 
Inflammatory element 
/Chill . 
Pain in the side . 
Dyspnoea 
Violent cough 

Difficult expectoration 



Variant. ( 



Adynamia . 

Full pulse . 
Weak pulse . 
Mild delirium 
Active delirium . 
Icterus . 
Elimination of the in 

fectious agent . 
Asphyxia 
Abscess 
Convalescence 



Sulphide of calcium. 

Aconitine. 

Sulphate of strychnine. 

Hydrochlorate of morphine. 

Digitaline, morphine, cicutine. 

Codeine, iodoform. 

Scillitine, arseniate of anti- 
mony, emetine, emetic. 

Wine, 'iodoform, arseniate of 
strychnine. 

Digitaline, veratrine. 

Hypophosphite of strychnine. 

Caffeine, bromide of camphor. 

Wine, hyoscyamine. 

Colchicine, calomel. 

Sedlitz Chanteaud. 

Vesicants, strychnine. 
Iodoform, arseniate of soda. 
Quassine, arseniate of iron. 



Pneumorrhagia. — See Broncho-pulmonary Haem- 
orrhage (under Hemorrhage). 

Pollutions, — See Spermatorrhoea. 

Pseudo-croup. — See Acute Catarrhal Laryngitis 
(under Laryngitis). 

Purpura Haeniorrhagica.— See Scorbutus. 

Rhachitis. — Podiatrists are not in accord with re- 
spect to the true cause of rhachitis. "While some con- 
sider that it depends upon and is one of the symptoms 
of hereditary syphilis, others affirm that syphilis is not 
at all necessary to its production, and that it results 
entirely from faulty nutrition, the organism excreting 
an excessive quantity of the inorganic elements which 
enter into the composition of the skeletal system. This 
opinion seems a reasonable one, and it is for that reason 
that the use of granulated phosphate of lime is recom- 
mended, a small teaspoonful to be taken with each 
meal. The hypophosphites of soda and lime will also 
fulfill this indication, and will have the advantage of not 
fatiguing the digestive organs, which sometimes hap- 
pens after large doses of phosphate of lime. Two gran- 
ules of the hypophosphite should be given at each 
meal. It is evident that this treatment must be con- 
tinued for a long time, these agents being considered 



420 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

as foods rather than as medicines. It must not be ex- 
pected that the organism can repair in a few days ex- 
tensive disorders of nutrition. The variant in this dis- 
ease has a manifest importance, since the greater num- 
ber of the symptoms which accompany it are the cause 
of serious troubles of nutrition, which must be avoided 
with the most assiduous care. If insomnia is an element 
of trouble, the child should receive two to four granules 
of codeine at bed-time. The fever which accompanies 
the appearance of acute rhachitis should be treated 
with half a granule of aconitine every hour, more or 
less, according to the condition of the temperature. 
After the period of invasion there may be other attacks 
at irregular intervals, which should be treated with one 
or two granules of the hydroferrocyanate of quinine 
every two hours. The muscular debility and general 
prostration which accompany this disease should be 
treated with neurosthenics, the most appropriate of 
which is brucine, which should be given three to five 
times daily. Codeine should also be given to control 
vomiting in one- or two-granule doses, and as often as 
is indicated by the urgency of the case. Sweating, 
which is more or less profuse in character, is a promi- 
nent symptom, especially during sleep, and tends to 
weaken the patient and predispose him to bronchitis 
and other catarrhal affections. For this condition we 
should give one to four granules of agaricine every 
evening. Diarrhoea, which results from intestinal 
atony and imperfect digestion, indicates one granule 
of phosphate of iron before each meal and two of pep- 
sin after each meal. Convulsions, which may proceed 
from different causes, may, nevertheless, all be cured 
by the use of two granules of the bromide of camphor 
and two of the valerianate of zinc every half-hour. 
Though it is not necessary to consider hereditary syph- 
ilis as the essential cause of this disease, nevertheless 
it furnishes conditions which are favorable to its devel- 
opment and which greatly aggravate the situation of 



ELEMENTS OF DOSIMETRIC PRACTICE. 



421 



the patient ; it should be persistently treated by means 
of one granule of the biniodide of mercury two to four 
times daily. If, for any reason, it is deemed proper to 
suspend the use of the mercury, iodoform may be 
given in doses of one or two granules three times daily. 
The foregoing directions will prove of little benefit un- 
less they are supported by the observance of suitable 
hygienic measures, new disorders being developed with 
great readiness when the departure from the physio- 
logical condition has reached a certain stage. 



m 



Dominant. 



Variant. ( 



Dystrophy as to cal 
careous elements 
/ Insomnia . 

Fever 

Weakness . 
Vomiting . 
Profuse sweating 
Diarrhoea . 

Convulsions 

\ Hereditary syphilis 



Phosphate of lime. 

Hypophosphites of lime and soda. 

Codeine. 

Aconitine, hydroferrocyanate of 

quinine. 
Brucine. 
Codeine. 
Agaracine. 

Phosphate of iron, pepsin. 
Valerianate of zinc, bromide of 

camphor. 
Biniodide of mercury. 



Rheumatism. — Pathologists are yet far from a 
perfect knowledge of the manner in which rheumatic 
diseases are constituted. Therapeutics can, therefore, 
dispense with an analysis of these contradictory theo- 
ries, since, if any one of them were true, it would de- 
stroy all the others and remove all doubts. Truth has 
for its characteristics unity and simplicity ; if a propo- 
sition can be contested, it is because it is either false 
or incomplete. It is repugnant to the scientific spirit 
of the day, however, to throw itself into the arms of 
empiricism. Reason must always struggle in its search 
for truth, and the intellect is compelled to take as a 
support an hypothesis which, without explaining all 
the facts at issue, will at least serve as a guide in the 
most of its endeavors. Such a method is the best one, 
after careful examination, for reaching the grand road 
which leads directly to the source of the true light for 
which we may be searching. The study of rheumatism 
shows that two conditions are essential to its produc- 



422 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

tion : 1 . Predisposition. 2. A determining cause. Pre- 
disposition consists in a chemical modification of the 
fluids of the body, uric or lactic acids being present in 
excess. The determining cause is unknown, but it 
would seem to be of an infectious nature. The similar- 
ity of the symptoms in true rheumatic arthritis and in 
blenorrhagic arthritis, in which the gonococcus is the 
true cause ; the facility with which rheumatism ap- 
pears in persons who are predisposed to it, in conse- 
quence of a simple change in the external surround- 
ings ; the fact that cerebral rheumatism may be cured 
by the use of cold baths ; the duration and course of 
the disease when it is left to a spontaneous evolution ; 
the multiplicity of its localizations ; the unquestion- 
able influence which is exerted upon it by the salicy- 
lates, the action of which is antizymotic ; all these con- 
siderations conduce to the opinion that rheumatism is 
due to an unknown zymotic agent, which is developed 
as the blood is modified by an excess of certain organic 
acids. However this may be, it is certain that the phy- 
sician is more fortunate in possessing a medicinal agent 
for the cure of rheumatism, the eflicacy of which has 
been proved, than in possessing a theory which is capa- 
ble of clearing away all doubts and explaining all phe- 
nomena. We can pass, therefore, to the study of the 
best means for treating and checking rheumatism, re- 
serving for a final consideration the explanation of their 
therapeutic action. The most varied methods have 
been used in the treatment of acute rheumatism, hav- 
ing nothing in common but their want of efficacy. It 
is only within the last few years that therapeutics has 
possessed a class of agents of recognized value — namely, 
salicylic acid and the salicylates. After a few days of 
treatment with these agents, the pain will be dimin- 
ished, the fever will disappear, and it will appear that 
the disease has been brought under control. But, aside 
from these advantages, there are certain disadvantages 
connected with the use of either the acid or its salts. 



ELEMENTS OF DOSIMETRIC PRACTICE. 423 

The doses must be very large, for it is necessary that 
the patient be saturated with the drug until the desired 
effect is obtained. The digestive organs will not always 
tolerate such excessive dosing, and it sometimes hap- 
pens that the physiological effects anticipate the thera- 
peutic, and thus leave the physician completely dis- 
armed and helpless, the patient being unrelieved, in- 
stead of obtaining a prompt and durable relief. The 
advantages which may be obtained are also only 
transient ; the slightest negligence on the part of the 
patient, the premature suspension of treatment, which 
should be continued for a long time, may give rise to 
a relapse which may prove much more rebellious than 
the first attack. Besides, intoxication may easily occur 
if the organs of elimination are not functionating prop- 
erly. Among the alkaloids may be found certain agents 
which are as effective as the salicylates, and even much 
more certain in their action. The author would prefer 
colchicine to the salicylates in the treatment of all rheu- 
matic affections, whether they involve the articulations, 
the serous membranes, or the nerves. Colchicum has 
always been used for gout, and, according to some au- 
thors, with an effect which is almost specific. It has 
not the same reputation for relieving rheumatism, al- 
though it would seem to be indicated for this as well 
as for gout. Its analgesic, antithermic, and derivative 
properties should indicate its use to fulfill all necessary 
requirements. The fear of giving such an active remedy 
until its full effect is obtained, the varying energy of 
its preparations, and the appearance of certain unpleas- 
ant symptoms, explain its limited use. The populariza- 
tion of the alkaloids had the advantage of recalling 
into use a great number of excellent drugs which had 
been abandoned on account of the imperfection and 
irregularity of the preparations in which they appeared, 
and also because the other elements which were asso- 
ciated with the useful alkaloid in the given plant dis- 
turbed the action of the alkaloid by their action, and 



424: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

nullified its results. The action of colchicine, however, 
is simple, evident, and prompt. In all cases of rheu- 
matism, whether simple or complicated, acute or chronic, 
colchicine may be given in accordance with two differ- 
ent methods — viz., the acute or active treatment, if the 
case is an acute one or an exacerbation of a chronic 
one ; the slow treatment, if the disease follows the usual 
chronic course. In the active treatment, two granules 
of colchicine should be given at intervals of two hours 
until the therapeutic or physiological effect is obtained, 
the former being indicated by a cessation of the pain, 
the latter by diarrhoea, and perhaps by vomiting of 
bile, following the administration of the medicine. 
Both these effects are usually obtained simultaneously. 
This result having been obtained, the medicine must 
be continued at the same intervals, but in doses of only 
one granule. By this means the excessive discharge 
of bile will quickly be controlled, the therapeutic 
effects continuing. The author has seen neither re- 
lapses nor aggravation of the disease after the treat- 
ment has been discontinued. In addition to the use 
of colchicine, the patient must abstain from the use of 
acid in all forms, including wine, which always contains 
tartaric acid, because acids will decompose the alka- 
loid and transform it into another, which is much less 
powerful in its effects. For diet, soups and milk 
should be given in acute cases ; in chronic ones we 
should simply insist upon abstinence from indigestible 
and irritating food. In the treatment of chronic cases, 
which include those which are accompanied by more or 
less continuous rheumatic pains, which may not be of 
great severity, and those which are accompanied by the 
presence of nodes, four to six granules of colchicine 
should be given daily. The physiological effect with 
such dosage is not apparent ; the therapeutic effect be- 
comes manifest after some time, but the treatment 
must be continued with regularity and perseverance. 
In st)me cases a succedaneum of colchicine will be of 



ELEMENTS OF DOSIMETRIC PRACTICE. 425 

service, the most useful one being veratrine, which re- 
sembles colchicine in many respects. It may be given in 
doses of two granules every half-hour, the general di- 
rections which were given for colchicine being also ap- 
plicable in respect to veratrine. The action of colchi- 
cine may be re-enforced by that of veratrine, two 
granules of each being given every two hours, or by the 
salicylates, three of the salicylate of soda or of quinine 
being given at intervals of two hours. In nodose rheu- 
matism, two granules of arseniate of soda may be given 
three times daily with an equal quantity of colchicine ; 
or the colchicine may be replaced with three granules 
of iodoform three times daily, and the arseniate of 
soda by three granules of the cyanide of zinc three 
times daily. This treatment should be continued for 
months, or even years. The author has almost entirely 
given up the treatment of rheumatism by external ap- 
plications, no advantage having ever been obtained 
from the various sedative, stimulant, anodyne, and re- 
vulsive applications, which are useful only to draw 
away the patient's attention from his immediate suffer- 
ings, and which exjDose him to relapses. In monar- 
ticular rheumatism, whether acute or chronic, subcuta- 
neous injections of colchicine may be made, four gran- 
ules of the colchicine being dissolved in a gramme of 
distilled water. According to 0. Hayfelden, of St. 
Petersburg, these injections have an almost miraculous 
effect, although the tissues may be somewhat irritated. 
Douches, sulphurous and saline baths, electrical appli- 
cations, etc., have indications and advantages which 
need not be insisted upon. After having thus estab- 
lished the treatment of the dominant, it will sometimes, 
though not often, be necessary to have recourse to other 
medicinal agents to combat troublesome symptoms. 
For the pain of this disease, we may combine with the 
dominant two-granule doses of cicutine hourly, or one 
of morphine every quarter-hour, or the morphine may 
be given hypodermically. Should the fever exceed 



426 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

39° C, one granule each of aconitine, veratrine, and 
digitaline may be given at intervals of one honr or 
more, but this must not imply any interruption in the 
administration of the colchicine, which should be con- 
tinued in accordance with the rules which have been 
given. Should there be the element of periodicity in 
the pain or the fever, we should associate with the 
other remedies the salicylate of quinine in doses of 
three to five granules at intervals of two hours. Sweat- 
ing may sometimes be too profuse and require treat- 
ment ; for this purpose a granule of atropine may be 
given every two hours until either the physiological or 
the therapeutic effect is obtained. Anaemia, which rarely 
occurs among those who are treated according to the 
principles of dosimetry from the beginning of the dis- 
ease, should be treated with the salicylate of iron and a 
strengthening diet. The cutaneous eruptions, which 
sometimes alternate with the rheumatic attacks, may 
be readily cured with colchicine. Pruritus should be 
treated with three-granule doses of the hydrobromate 
of cicutine every half -hour. The complications, endo- 
carditis, pleuritis, peritonitis, pneumonitis, and menin- 
gitis, should receive the same treatment as that which 
is used for the inflammation of the joints, that is, col- 
chicine, and the variable symptoms arising from the 
complications by the variant which is appropriate for 
each. Rheumatic encephalopathy is the gravest of all 
the complications which may occur, and was long con- 
sidered quite incurable. The danger in encephalopathy 
consists in hyperthermia. In this condition hesitation 
is not to be thought of, and we should at once make 
use of a combination of all the hypothermic agents in 
as active a form of treatment as possible, for this com- 
plication may be fatal in the course of a few hours. 
Two granules of aconitine should be given with four of 
veratrine, one of digitaline, and two of colchicine every 
half -hour, the quantity of each substance and the in- 
tervals between the doses being regulated by the effects 



ELEMENTS OF DOSIMETRIC PRACTICE. 427 

which are produced. The value of cold baths must not 
be overlooked ; in many cases they will prove the only 
means of preserving health. In all cases the thermome- 
ter must be resorted to as a guide for regulating the 
treatment. The temperature of the bath should be 
25° C, and this may be kept constant either by the ad- 
dition of cold water or ice. The patient should remain 
in the bath until his temperature is considerably re- 
duced. After having been dried and rubbed, he 
should receive stimulating drinks ; should the tempera- 
ture rise again, the baths should be repeated until the 
bad symptoms have disappeared. The author hesitates 
to advise the simultaneous use of the cold baths and 
the dosimetric treatment by means of defervescents. 
He has never adopted this plan in his own practice, 
though it has been done with advantage by other phy- 
sicians. In any case in which either of these methods 
used alone does not produce the desired result, the cir- 
cumstances of the case will indicate whether he should 
resort to extreme measures and combine internal with 
external measures of refrigeration. It is of great im- 
portance that no time be lost in moderating the febrile 
condition, whatever method be employed. The author 
will not attempt to explain the manner in which cere- 
bral rheumatism may be cured by means of refrigerant 
remedies, but will simply conclude this chapter by 
attempting to explain the action of colchicine. The 
most evident action of colchicine is that of a cholagogue. 
Is it the excessive biliary and intestinal secretion that it 
excites, which, by modifying the condition of the blood, 
removes the elements which convert it into a medium 
that is suitable for the development of the rheumatic 
condition % Is it its irritating action upon the intestine, 
which, by removing the inflammation in the joint, dis- 
sipates the arthritis \ Does it relieve the pain by act- 
ing upon the general sensibility? Or is it a combi- 
nation of these effects which, by attacking the disease 
in its principal constituent elements, destroy it, dissolve 



428 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



it, or check it ? The recognized efficiency of antimony 
in the treatment of rheumatism seems to justify the lat- 
ter view, but the parallelism is entirely in favor of 
colchicine, which appears to have particular properties 
as an anti-rheumatic agent. The local action of colchi- 
cine, which Hayfelden has declared to be admirable, 
justifies the hypothesis that this agent possesses cer- 
tain specific properties. 

Acute rheumatism . 



/ Dominant. 



f Ordinary 
Chronic rheu- form . 



matism 



[ Nodose 



\ Variant. ( 



j Colchicine, veratrine, sali- 
"j cylates. 

(■ Colchicine, cyanide of zinc. 

( Colchicine, arseniate of 

-j soda. 

( Iodoform, cyanide of zinc. 

Pain Cicutine, morphine. 

Continued \ Ac ™itine, veratrine, digi- 
tanne. 
Salicylate of quinine. 
Atropine. 
Salicylate of iron. 
Colchicine. 
Hydrobromate of cicutine. 



Fever 

Periodic 
Profuse sweating 
Anaemia 
Eruptions . 
Pruritus . 
Carditis 
Pleuritis . 
Peritonitis 
Pneumonitis 
Meningitis 
V Cerebral rheumatism 



Colchicine, aconitine. 
Variant as in each disease 
taken by itself. 

Defervescents, cold baths. 



Rhinitis (Coryza). — Acute rhinitis may proceed 
from several causes, the most common of which consists 
in atmospheric changes, and this is the one which it is 
most important for the physician to recognize in prac- 
tice. Coryza is the type of catarrhal diseases. With- 
out danger when it is simple and properly treated, it 
may become the cause of different annoying conditions 
if it is allowed to pass into the chronic state, whether 
from disregard of the proper hygienic and pharmaceu- 
tical means of treatment, or from neglect of the indica- 
tions furnished by any morbid condition whatsoever 
which maintains it or predisposes to it. However be- 
nign this inflammation may be, we should not leave it 
to take its natural course, which frequently does not 
result in complete resolution. Besides, the longer a 
coryza lasts the more chances are there for successive 



ELEMENTS OF DOSIMETRIC PRACTICE. 429 

relapses, not to speak of the baneful influence which it 
may have upon contiguous organs — the pharynx, con- 
junctivae, ears, larynx, bronchi, etc. The dominant in- 
dication in acute rhinitis is to combat the catarrhal 
inflammation by the use of one granule of aconitine 
every hour, and to restore the suppressed perspiration 
by means of six granules of the nitrate of pilocarpine 
every quarter-hour until diaphoresis results. Perspi- 
ration having been excited, aconitine is to be continued. 
Aconitine does not limit itself to assisting this diapho- 
retic action and opposing the inflammation of the nasal 
mucous membrane ; it will promptly relieve the head- 
ache and counteract the catarrhal fever. After the 
antithermic effect has been obtained, aconitine may be 
alternated with the hydroferrocyanate of quinine, three 
granules being given every two hours. The acute pe- 
riod of the disease is quickly followed by that of mu- 
cous secretion, and the function of secretion and elimi- 
nation may be aided by the use of three to five granules 
of the sulphide of calcium every two hours, or two 
granules of helenine every three hours. Should the 
secretion be too abundant a granule of atropine every 
three hours will promptly modify it. Epistaxis at the 
beginning of the disease is almost always useful, but, 
should it become troublesome, three granules of ergo- 
tine may be given every quarter-hour until hsemostasis 
results. Infants at the breast, being very sensitive to 
the action of cold, are also very susceptible to coryza, 
At this early age the disease is not without gravity, on 
account of the obstacle which obstruction of the nares 
offers to the act of sucking. The application of fatty 
substances to the root of the nose, over the frontal 
sinuses, and within the nares, will promptly restore the 
ability to breathe through the nose. Persons who are 
subject to catarrhal troubles ought, especially during 
the winter and spring, to use habitually two granules 
of strychnine and two of aconitine at bedtime, and Sed- 
litz Chanteaud early in the morning. Hydrotherapy, 



430 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

in the form of daily intranasal injections of cold water, 
will also be found serviceable. Acnte coryza, in con- 
nection with infectious diseases, requires no particular 
treatment in addition to that which is directed toward 
the principal morbid condition. The sulphide of cal- 
cium should be the dominant in such cases. Chronic 
rhinitis is almost always due to some diathetic fault, 
and especially to scrofula. Three granules of iodoform 
and two of the arseniate of soda three or four times 
daily, saline baths, nutritious diet, cod-liver oil, and 
astringent tonic wines, are the most efficient means for 
the successful treatment of chronic rhinitis of scrofu- 
lous origin. Herpes and syphilis often render this con- 
dition an incurable one. For such cases the antiher- 
petic and antisyphilitic agents are indicated. Ulcerative 
coryza or ozsena is caused by an ulcerated condition of 
the nasal mucous membrane, which results in a fetid 
condition of the air which is expired through the nos- 
trils, although the latter condition may be present even 
if the ulcers are absent, owing to putrefaction of the 
muco-purulent secretions of the nasal mucous mem- 
brane. The internal treatment should be that of simple 
chronic coryza, but the local trouble should be treated 
by local applications of antiseptic agents, the best of 
which are the following : 

(1) IJ Iodoformi porphyrisati, 

Bismuthi subnitr., 
Aluminis pulv., aa partes sequales. 
M. et ft. pulvis. 

(2) 9 Aquse, 

Liq. Goudron aa q. s. M. 

(3) ^ Potassse permang 1 gramme. 

Aquse 100 grammes. 

M. Sig. : First inject plain water into the nostrils, 
then follow with the foregoing. 

(4) ^ Yaselini 25 grammes. 

Calomelani 2 grammes. 

M. Sig. : Introduce into the nostrils upon cotton. 



ELEMENTS OF DOSIMETRIC PRACTICE. 



431 



Acute rhinitis 



Dominant. 



Variant. 



RHINITIS. 

Catarrhal element Nitrate of pilocarpine. 
Infectious element Aconitine. 

Chronic rhini- f Scrofulous element j Io *°^ rm ' arSeniate ° f 
tis (simple! Herpetic element Arsenious acid. 
or ulceraO i , Protiodide of mercury, 

tive) . . I Syphilitic element -j iodoform. 

I Cephalalgia Aconitine. 

( Hydroferrocyanate 

* 1 quinine. 
] Sulphide of calcium. 

* \ Helenine, atropine. 

Epistaxis Ergotine. 

Fetid secretions .... Antiseptic errhines. 



Intermittent fever . 
\ Catarrhal secretion 



of 



Rubeola. — This disease is considered a benign one 
by many writers, but it deserves a certain degree of 
attention on account of the dangers which attend either 
the expectant plan of treatment or any other method 
which is inappropriate to the nature of the disease. 
Sporadic cases are properly designated by the name 
which the Italians give to the disease — morbillo, that is, 
the slight or insignificant disease; but when the 
disease becomes epidemic it may be one of the most 
destructive as to its termination, from the complica- 
tions which are associated with and follow it, if not from 
the evolution of its parasitic elements. It is not neces- 
sary, at this time, to criticise the work which has been 
done with reference to the proper treatment of this dis- 
ease. We can limit ourselves to the opinion of Franz 
Mayer, professor of the diseases of children at Saint 
Anna's Hospital for children in Vienna, and which is 
given in Hebra's "Treatise on the Diseases of the 
Skin " : " We do not know of any medicament which 
will guarantee a favorable termination to measles. 
This opinion resul ts from a comparison of cases which 
have followed their course without medical treatment, 
with other cases treated by both old methods and new. 
In whatever way one may treat them, the result is 
always the same. In all cases, it will be proper to 
refrain from using diaphoretics and alteratives, for, 
though they may facilitate to a certain degree the 



432 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

natural course of the evolution of the eruption, they 
may also favor the development of certain complica- 
tions. With reference to the consequences, it must not 
be forgotten that affections of this kind are frequently 
the result of scrofula, tuberculosis, ansemia, or poor 
food. The use of medicaments internally, which is in- 
dicated by the existence of one of these conditions, 
will almost always prove useless on account of the 
rapid progress of the complications." The conclusion 
from this passage, which is an expression of the senti- 
ments of the great majority of regular practitioners, is 
therefore in effect : Complications are to measles as 
effects to their causes— for the causes, apply the expect- 
ant plan of treatment ; for the effects, use ineffective 
treatment. Dosimetry is more logical as well as more 
humane. With this system of treatment the problem 
is to eliminate the causes so as to prevent the primary 
effects from being produced ; then, if primary results 
have occurred, to treat them and prevent secondary 
ones. Of what use is pathology, why do we study the 
succession and dependence of morbid phenomena, if no 
practical advantage can be drawn, if we must be lim- 
ited to the contemplation of the natural course of 
diseases? In the zymotic, parasitic, infectious dis- 
eases, etc., the knowledge of the primordial pathologi- 
cal cause imposes an indication of great importance— 
namely, the extirpation of the microbes which are dis- 
tributed through the system of the patient. In the 
present state of science prophylactic treatment consists 
in inoculation with the virus of the disease which has 
been so attenuated as to produce harmless results ; 
curative treatment should find a bactericide which will 
be effective in its action upon microbes, and will be 
tolerated by the organism. If this fundamental indica- 
tion is filled, it is evident that the therapeutic problem 
will be much simplified, for the task will then be to seek 
for agents to eliminate the residue of the invading mi- 
crobes, and to sustain Nature in her efforts to heal 



ELEMENTS OF DOSIMETRIC PRACTICE. 433 

their ravages. Sulphide of calcium, the bactericide 
which is so effective in the treatment of variola and 
croup, if employed in accordance with rules which are 
indispensable for obtaining the desired effect, will be 
equally successful in the treatment of rubeola. Infec- 
tion by this disease, which is less violent, less general, 
and less acute than variola, requires a no less active 
treatment than variola if one would destroy it in a few 
hours. It is not necessary to repeat the pathogenic 
considerations which are given at length under the 
head of variola ; they will apply equally in this disease 
with reference to the administration of sulphide of cal- 
cium. In rubeola the plan of aborting the disease is 
not often necessary, because the period of invasion is 
usually longer and the precursory symptoms less char- 
acteristic than is the case in variola. In the period of 
invasion we should therefore give one granule of the 
sulphide of calcium every half -hour or every quarter- 
hour, according as the condition is more or less remote 
from the period of eruption. In this period we should 
satisfy the more urgent indications of the variant. We 
should give aconitine if the temperature is high or if 
there is delirium or convulsions, combining it with the 
bromide of camphor or croton chloral, in two-granule 
doses every hour, if perturbations of the nervous sys- 
tem follow the fever. The violent headache should be 
treated with one granule of caffeine every half-hour, the 
cough with one granule of codeine every quarter-hour, 
and the paroxysms of spasmodic suffocation with one 
granule of hyoscyamine every hour. If we are called 
to a case during the period of eruption we should con- 
tinue the use of the sulphide of calcium, for the funda- 
mental indication still exists ; we may give it, however, 
in one-granule doses every hour. In that form of the 
disease in which the function of elimination seems to 
be localized in the respiratory apparatus, we must treat 
the prostration and ward off collapse by the use of 
one granule of brucine or of the hypophosphite of 

28 



434 ELEMENTS OF THERAPEUTICS AND PRACTICE, 

strychnine every hour, and we should facilitate expec- 
toration by means of one granule of emetine, kermes 
mineral, or scillitine, every two hours. In the neurotic 
or ataxo-dynamic form of the disease, we should use, 
in a liberal manner, arseniate of strychnine, phosphoric 
acid, and valerianate of quinine ; one granule may be 
given every hour. Generous wine or quinquina, in 
small and often repeated doses, are also excellent aux- 
iliary means of treatment. In the hemorrhagic form, 
the chances of recovery are few, and the best plan is to 
prevent the occurrence of the disease by the use of bac- 
tericides. Should it actually occur, however, we should 
give one granule each of ergo tine, tannic acid, and sali- 
cylate of ammonia. In the period of desquamation, 
the dominant is furnished by the asthenic condition, 
and should be satisfied with quassine and strychnine. 
The variant will have reference to the persistence of 
certain symptoms which denote that elimination con- 
tinues in progress at certain points in the organism. 
We should give Sedlitz Chanteaud, colchicine, benzoic 
acid, or the benzoates, to stimulate the functions of the 
emunctories. Such is the rational treatment of rubeola, 
which has been demonstrated by practical experience 
to be the most effective. A few years ago, when the 
author was still occupied with practice in the regular 
school, he assisted in the treatment of an epidemic of 
rubeola in which the mortality was greater than in an 
epidemic of variola, in which he was also concerned. 
All the patients died from the sequela, which were 
bronchitis or enteritis. Since that time all the sporadic 
cases in the author's practice have been treated with 
the sulphide of calcium, with the result of modifying 
the course of the disease. In three or four days after 
the eruption appeared, the patients were able to be 
about. Not long ago the author was called to see a 
patient who presented the most pronounced symptoms 
of rubeola which he had ever seen. The fever reached 
40° C, the conjunctivae were injected, and there was 



ELEMENTS OF DOSIMETRIC PRACTICE. 



435 



continuous weeping ; there was a hoarse cough and 
coryza, the eruption was prominent, being abundant 
upon the limbs, but very slight upon the trunk. A gran- 
ule of the sulphide of calcium was ordered every hour. 
On the following day great improvement was manifest ; 
the con junc tivse were white and had only the normal 
quantity of moisture, the coryza had disappeared, the 
eruption was less prominent, but the cough still con- 
tinued to fatigue the patient, and the temperature had 
reached 38 '5° C. Two days afterward the disease 
seemed to be entirely overcome. This result may not 
have been due to the treatment alone. The disease 
would probably have been of a benign character, but it 
is certain that the influence of the drug upon the prog- 
ress of the disease was a positive one for good. 

RUBEOLA. 

Dominant. 
Parasitic infection Sulphide of calcium. 



1st period : 
Invasion. 



2d period : 
Eruption. 



3d period : 
Desquamation. 



Variant. 

Fever 

Cough 

Pseudo-croup 
Cephalalgia. 

Delirium, convulsions 

Capillary bronchitis (pul- 
monary form) . 

Ataxo-adynamic condition 
(neurotic form) 

Epistaxes, hematuria, pete- 
chias (hemorrhagic form) 
f Asthenic condition 

-j Retention of the products 
of infection 



Aconitine, salicylate of 
quinine. 

Codeine. 

Hyoscyaraine. 

Caffeine, guaranine. 

Bromide of camphor, cro- 
ton chloral. 

Brucine, hypophosphite of 
strychnine, emetine, scil- 
litine. 

Phosphoric acid, valerian- 
ate of zinc, generous 
wine, quinquina. 

Ergotine, salicylate of am- 
monia, tannic acid. 

Quassine, strychnine. 

Sedlitz Chanteaud, colchi- 
cine, benzoic acid, ben- 
zoates. 



Scarlatina. — Scarlatina, like the other eruptive 
fevers, is due to the infection of the organs by a par- 
ticular microbe, the destruction of which may be ac- 
complished by means of the sulphide of calcium, which 
acts not only to cure the patient, but also tends to pro- 
tect those who are exposed to the morbid germ. The 



438 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

internal disinfection should be carried out with the 
same earnestness and by the same method which is 
advocated for variola, that is, one granule of the salt 
every quarter-hour, whether the patient be a child or 
an adult, only short intervals being allowed, when the 
system seems to be saturated with hydrogen sulphide. 
In addition to the dominant, which is indispensable 
and may be used during the entire course of the disease, 
other agents must occasionally be employed to fill 
secondary indications, but this will occur, as a rule, 
only in cases in which the dominant has not been used 
from the beginning to control the pathogenic element. 
In the period of invasion it may happen, in certain 
cases, that the chill, on account of its violence, will 
demand the use of the neurosthenic agents, especially 
the arseniate of strychnine, in one-granule doses every 
quarter-hour, in order to diminish the vaso-motor pa- 
ralysis which follows this spasmodic condition. When 
the invasion is suspected, the salicylate of quinine, in 
one-granule doses every quarter-hour, may be advan- 
tageously combined with strychnine. Cephalalgia and 
fever may be relieved by aconitine, one-granule doses 
being given at such intervals as may be indicated by 
the temperature. If the fever exceeds 39*5° C, we 
should give aconitine every quarter-hour, being satis- 
fied with a moderation of the temperature which shall 
approach the normal, since the sulphide of calcium has 
a true defervescent action in such cases, by controlling 
the parasitic infection. When the patient complains of 
pain in the throat, he should be instructed to dissolve a 
granule of aconitine in the mouth at suitable intervals, 
which will rapidly soothe the irritation of the pharynx. 
Should the angina become worse, three granules of 
cocaine may be given every half-hour until a sedative 
effect is obtained. Non-suppurative parotiditis should 
be treated with two granules of the nitrate of pilocar- 
pine every half-hour, to facilitate the elimination of the 
virus of the disease ; while the suppurative form may 



ELEMENTS OF DOSIMETRIC PRACTICE. 437 

be treated with one granule each of iodoform and 
arseniate of quinine every hour. Adenitis of the 
cervical glands should be treated in the same way. In 
the very grave forms of the disease, the nervous agita- 
tion, delirium, and ataxia may be relieved with two 
granules of the bromide of camphor every half -hour. 
The convulsions, should they not yield to the use of 
the camphor, may be treated with two granules of the 
valerianate or the hydrobromate of quinine every 
quarter-hour. For somnolence or the comatose condi- 
tion, two granules of caffeine or of one of its salts 
may be given every quarter-hour. For adynamia, 
two granules of the arseniate of strychnine should be 
given every two hours, or, if the progress of this con- 
dition is a slow one, caffeine and generous wine may 
be administered. Vomiting at the beginning of the 
disease is not significant, but, should it occur after the 
eruption has appeared, it would indicate that the 
digestive canal was taking part in the work of depura- 
tion, which should be facilitated by the use of Sedlitz 
Chanteaud. The act of vomiting, which fatigues the 
patient and aggravates his general condition, may be 
checked by the use of two to four granules of codeine 
or Gregory's salt every half -hour. Cutaneous and in- 
ternal haemorrhages are of grave prognostic signifi- 
cance. Two to four granules of ergotine, with one or 
two of salicylate of iron every hour, are means which 
offer the best results. Attacks of syncope are due to 
infectious myocarditis. The tonicity of the heart may 
be increased by using three granules of caffeine and 
three of ergotine every half-hour. Diphtheritic de- 
posits upon the tonsils and pharynx should be treated 
locally with applications of lemon- juice, and three 
granules of nitrate of pilocarpine should be taken in- 
ternally every two hours to facilitate the separation of 
the false membrane. Gangrenous conditions should 
be treated with two granules of salicylate of ammonia 
and two of quinine every hour. Albuminuria, anasarca, 



438 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



and ursemic accidents should receive appropriate diu- 
retic and laxative treatment ; for example, one granule 
of digitaline and one of aconitine three times daily, 
or two granules of asparagin every hour ; and a dessert- 
spoonful of Sedlitz Chanteaud in a glass of water as an 
ordinary beverage. The benzoates are also useful when 
the albuminuria has begun to diminish, two granules 
being given four times daily. Great care must be 
taken to avoid chilling the cutaneous surface, or pre- 
venting in any way the process of elimination by the 
other emunctories. 





! Dominant. 


Infectious element 


Sulphide of calcium. 






/Chills . 


Arseniate of strychnine. 


< 




Headache 


Salicylate of quinine. 


ft 




Fever . 


Aconitine. 


En 




Angina 


Cocaine. 


5( 




Parotiditis . 


Nitrate of pilocarpine. 




Cervical adenitis . 


Iodoform, arseniate of quinine. 


< 




Nervous agitation 


) 

V Bromide of camphor. 


o 




Ataxia . 






Delirium 






Convulsions . 


Valerianate of quinine. 


\ Variant. { 


Somnolence . 


Caffeine. 




Adynamia . 


Arseniate of strychnine. 




Vomiting 


j Sedlitz Chanteaud, codeine. 
( Gregory's salt. 




Haemorrhage 


Ergotine, salicylate of iron. 




Syncope 


Ergo tine, caffeine. 




Diphtheritic deposits 


Nitrate of pilocarpine. 




Gangrene 


{ Salicylates of ammonia and of 
( quinine. 




Albuminuria 


) Digitaline, aconitine, nspara- 
) gine, Sedlitz Chanteaud. 






^Anasarca 



Sclerosis of the Brain. — See Chronic Encephalitis. 

Scorbutus and Purpura Hemorrhagica, or 
WerlhofPs Disease. — Scorbutus and purpura should 
be studied together, since they differ only in the acuity 
of their progress and the rapidity with which they are 
established. It might be said that purpura is acute 
scorbutus, or, on the other hand, that scorbutus is 
chronic purpura. Let us endeavor to find the true 
cause of this disease, as well as its fundamental lesions. 
Up to the present time we are entirely ignorant of the 
conditions which excite this change in the health. We 
know that it appears under the influence of bad hygi- 



ELEMENTS OF DOSIMETRIC PRACTICE. 439 

enic conditions, and that alimentation bears a particu- 
lar relation to it ; but it is often observed, also, after 
depressing experiences of a moral nature, and some- 
times without anything in the previous history of the 
patient which could be taken as a clew. From its 
usual etiology, from its symptomatology, and from the 
result of certain modes of treatment, it may be con- 
cluded that the primordial cause of scorbutus is a hy- 
posthenic condition of the venous system. The domi- 
nant should consist, therefore, in the use of ergotine 
and the lactate or salicylate of iron, one granule of each 
being given every two hours. The normal solution of 
the perchloride of iron may also be used in doses of 
thirty or forty drops daily. Pains in the extremities 
may be relieved by the use of three granules of the 
hydrobromate or the valerianate of quinine every hour. 
For constipation, five granules of podophyllin should 
be given two or three times at intervals of two hours. 
The diarrhoea, which is almost always of a fetid char- 
acter, may be controlled by using three granules of the 
salicylate of quinine or three of tannic acid every two 
hours. Syncope, which is very dangerous in the ady- 
namic condition of the patient, should be treated with 
three granules of caffeine every five minutes, or with 
subcutaneous injections of ether, half a gramme being 
injected every half-hour until a satisfactory result has 
been obtained. For haemorrhages we may use five 
granules of ergotine with one of sulphate of strychnine 
every quarter-hour. Not infrequently there are spasms 
which are due to stimulation of the muscles by the de- 
teriorated blood. If they are painful or very vio- 
lent, one granule of valerianate of atropine should be 
given every half-hour until relief is obtained. The 
stomatitis does not require any particular treatment. 
Some topical application of a disinfectant and astrin- 
gent character should be used, however, to improve the 
circulation of the gums, and prevent the ulcerations 
and haemorrhages which frighten so many patients. 



440 ELEMENTS OF THERAPEUTICS AND PRACTICE. 



Dominant. Venous hyposthenia 
/ Pain . 
Constipation 

Diarrhoea 




This indication may be met by occasionally dissolving 
in the mouth a granule or two of iodoform and brucine, 
or rinsing out the mouth with an alcoholic solution of 
chlorate of potash of the strength of 15 : 200. The 
vegetable acids, antiscorbutic plants, etc., need not be 
used, for nothing but a vague tradition as to their spe- 
cific properties sanctions their use. Ergotine and iron 
are the true remedies for this disease, and they have 
been tried by different therapeutists with a uniform 
degree of satisfaction. 

Ergotine, iron. 
Valerianate of quinine. 
Podophyllin. 
j Salicylate of quinine, tannic 
( acid. 
( Syncope . . . Caffeine, injections of ether. 
Hemorrhage . . | Ergotine, sulphate of strych- 

Spasm .... Valerianate of atropine. 
\ Stomatitis . . • Iodoform, brucine. 

Scrofula. — The cause of scrofula is still unknown. 
The parasitic theory which places it by the side of tu- 
berculosis, although very seductive, does not explain 
all the facts of the disease. The facility with which 
some of its symptoms are relieved — for example, the 
conjunctivitis — by the use of saline baths appears to 
indicate that the disease proceeds principally from an 
atonic condition of the lymphatics, which gives rise to 
irregularities in the lymph circulation, which are mani- 
fested by engorgements with inflammation and subse- 
quent suppuration. The primordial lesion, according 
to this hypothesis, is a functional perturbation, which 
consists in a general hyposthenia, more pronounced in 
the lymphatic system than in any other. The result 
of the use of stimulating medicaments supports this 
supposition, and, therefore, we can establish as the 
dominant juglandine and phosphoric acid. The prep- 
arations of Juglans regia are to be classed among the 
bitter astringents, and the antiscrofulous properties of 
the drug have been known for a century. Baumes, 
Negrier, and Pouguet have carefully studied the results 






ELEMENTS OF DOSIMETRIC PRACTICE. 441 

of this treatment, and are in harmony in recognizing it 
as superior to all others. The variability of action of 
the preparations which are made from this plant, and 
the intolerance of the stomach for an irritant agent 
which must be continued for a long time, explain the 
oblivion into which these preparations had fallen. The 
alkaloid, which is without these inconveniences, enables 
us to continue the use of the drug as long as is neces- 
sary ; but it must be remembered that the first effects 
are always produced slowly, and that it is indispensa- 
ble that we persevere in its use for a long time. Three 
to four granules should be given three times daily be- 
fore each meal. Phosphoric acid is equally useful for 
this disease on account of the general stimulation which 
is produced, by which also the lymphatic system is 
benefited. Phosphorus has long been regarded as one 
of the best remedies for scrofula, but it has incon- 
veniences which do not exist in phosphoric acid. We 
can begin by using two granules three times daily, 
gradually increasing the dose if a favorable result is 
not obtained at the end of three or four weeks. The 
lymphatic diathesis is an almost inseparable companion 
to the scrofulous. This predisposition likewise serves 
as an obstacle to the cure of the latter. Should it show 
itself, it should be treated with a combination of iodo- 
form and arseniate of iron if it appear in the torpid 
form, or with arseniate of soda if in the irritable or 
erethistic form, two granules of each being given three 
times daily. In cases which are attended with sup- 
puration we should persevere in the use of the domi- 
nant, giving two granules of iodoform, combined with 
two of arsenious acid, three times daily. The glands 
which do not suppurate may be saved by injecting six 
to twelve drops of Fowlers solution. Those glands 
which have opened should be dressed with iodoform 
or with glycerole of phenic acid. The local phenomena 
upon the skin and mucous membranes may be modified 
by the stimulant action of sulphide of calcium, two or 



442 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

three granules being given f onr times daily. The local 
developments in the skeleton will require, in addition 
to the dominant, iodoform and hypophosphite of strych- 
nine ; for the local develoiDments in the viscera we 
should use iodoform and arseniate of strychnine. All 
hygienic means which will stimulate the circulation 
will greatly aid the pharmaceutical treatment. Gym- 
nastics, exercise in the open air, sunshine, cold baths, 
etc., should form a part of every plan of treatment. 
The diet should be substantial and varied, condiments 
being allowed in moderation. The appetite should 
always be watched, and, if it should appear to fail, it 
may be stimulated by means of three granules of quas- 
sine or of pipeline before each meal. 



Dominant. Atony of the lymphatics Jnglandine, phosphoric acid. 

'Lymphatic j Torpid . Arseniate of iron, iodoform, 

diathesis ( Irritable . Arseniate of soda, iodoform. 

Anorexia . . . Quassine, piperine. 

Suppuration . . Iodoform, arsenious acid. 



Localizations upon the "1 
mucous membranes . J 



VVaeiakt. ( Lo s c k a t a - tions - llpo - nth ; ^Sulphide of calcium. 



Localizations in the j Iodoform, hypophosphite of 

skeleton . . . / strychnine. 

Localizations in the \ Iodoform, arseniate of strych- 

viscera . . . \ nine. 

Septicemia. — See Traumatic Fever (under Fever). 

Spasm of the Glottis. — Spasm of the glottis is a 
contraction of the vocal muscles which results from 
exaggerated excitability of the spinal nerves. As the 
spasm lasts only a few minutes, one has no time to 
interfere ; the attack either ceases or destroys the pa- 
tient before the surprise which it excites has passed 
away. The treatment should have for its end, there- 
fore, the diminution of nervous excitability ; for, as the 
disease is rarely limited to one attack, and as there are 
always long intervals between the first attacks, we ought 
not to give way to an inaction which may result fatally. 
On the other hand, we should profit by this interval, 
and give atropine for a long time in doses proportionate 
to the age and tolerance of the patient ; say, from half 



ELEMENTS OF DOSIMETRIC PRACTICE. 



413 



a granule to a granule two or three times daily. Con- 
stipation, which is the most frequent cause of the con- 
dition, should be treated with one to three granules of 
podophyllin once daily ; or the bowels of young chil- 
dren may be regulated by the use of three granules of 
jalapine once or twice daily. These attacks sometimes 
recur with a certain periodicity, in which case we should 
administer one granule of hydroferrocyanate of quinine 
every two hours during the forty-eight hours which 
follow the spasm. This dose may be doubled or even 
trebled for children more than two years of age. If the 
attacks are repeated at regular intervals of greater du- 
ration, with the atropine we may combine two granules 
of the hydroferrocyanate or the hydrobromate of qui- 
nine three times daily. During and after the spasm, 
contractures and convulsions sometimes occur. Two 
granules of croton chloral or of bromide of camphor 
may be given every quarter-hour, or oftener, for the 
first, and two granules of the valerianate of zinc every 
half- hour or one of phosphoric acid every two hours 
for the convulsions. The phosphoric acid is especially 
useful in eclampsia of a severe form in delicate chil- 
dren. If the spasm continues very long, apncea and 
asphyxia will result. The only way to interfere with 
the necessary rapidity is to cause ether to be inhaled, 
or to excite the nerve force at another point by the aid 
of Mayor' s hammer or by burning a small quantity of 
alcohol upon the skin. 



GO 



ffi f Dominant, J Excitability of the 



Variant. 



nerves 
Convulsions 
Contractures 
Constipation 
Apncea . 
Asphyxia . 

Recurrences 



P inal [Atropine. 



Valerianate of zinc. 
Croton chloral. 
Podophyllin. 

Ether, Mayor's hammer. 

Ilydroferrocyanate of qui- 



Spermatorrhoea. — Spermatorrhoea is a functional 
lesion, quite analogous to incontinence of urine, and 
might with greater propriety be called incontinence of 



444 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

semen. It should be considered as diurnal and as noc- 
turnal spermatorrhoea. The nocturnal variety is essen- 
tially caused by congestion of the genito-urinary organs 
which, by the centripetal impressions which they send 
to the cerebro-spinal system, produce erotic dreams in 
the brain, and excite in the cord the centers which de- 
termine erection of the penis. This congestion results 
most frequently from distention of the bladder by an 
accumulation of urine. The principal indications, there- 
fore, will be — 

1. To urinate as often as necessary during the night, 
and to drink but little at the last meal. This precau- 
tion will often suffice to prevent pollutions, which al- 
most always occur in the morning when the bladder is 
full. 

2. This susceptibility of the bladder to congestion 
and tendency to seminal discharge certainly proceed 
from atony of the excretory canals, from weakness of 
the muscular coat of the bladder, and from failure in 
the vaso-motor force of its vessels. It is therefore in- 
dispensable that an excito-motor be administered which 
shall be capable of furnishing to these elements the 
force by which they are deficient. Therefore, the sul- 
phate or hypophosphite of strychnine, ergotine, or bru- 
cine will constitute, with the other neurosthenics, the 
dominant of the treatment. Aconitine will have a spe- 
cial influence upon the hyperemia of the bladder. 

3. Another element which contributes to the morbid 
condition is the exaggeration of the vesical sensibility 
and the increase of reflex action, by virtue of which 
ejaculation is accomplished. Cicutine should therefore 
be associated with the dominant in the plan of treat- 
ment, which thus becomes a complex one; and, in- 
deed, dynamic lesions in themselves are complex. The 
treatment should therefore consist in the use of two or 
three granules of strychnine with each meal, together 
with three granules of ergotine, and at bed-time three 
granules of cicutine and two of aconitine. It often 



ELEMENTS OF DOSIMETRIC PRACTICE. 445 

happens that the patient, unaware that the bladder is 
full, does not awaken sufficiently to urinate, and, the 
urinary secretion continuing, the pollution takes place 
as has been explained. The cerebral torpor, which be- 
comes the more pronounced the more frequent the pol- 
lutions, should be treated with two granules of atropine 
at bed-time and two more in the middle of the night. 
Diurnal pollutions are of much greater gravity and 
more rebellious than nocturnal ones. Not only do they 
destroy the vitality of the patient more quickly, but 
they are the evidence of a more profound perturbation 
of the nervous forces. For this condition we should 
use curative means with the greatest perseverance, be- 
cause the consequences are often disastrous, whether 
they lead to marasmus and phthisis or to suicide or 
mental disorders. In this condition the vital force 
should be increased by every means. For loss of appe- 
tite we should give three granules of quassine or two of 
piperine before each meal. Apepsia, which tends to 
debilitate the patient and aggravate the spermatorrhoea, 
should be treated with three granules of pepsin after 
each meal. Impotence, which is the inevitable conse- 
quence of weakness in the genital organs, will disappear 
entirely or in part, after the cure of the spermatorrhoea, 
by the prolonged use of three granules of the hypo- 
phosphite of strychnine two or three times daily. Gen- 
eral debility is very decided after this condition has 
lasted some time. When it appears, we should pre- 
scribe two granules each of the arseniate of iron, ar- 
seniate of strychnine, and phosphoric acid with each 
meal. Fecal retention must be carefully avoided, so 
much the more because spermatorrhoea conduces to 
irregularity in the evacuations of the bowels. The pa- 
tient should take a small spoonful of Sedlitz Chanteaud 
in water every morning, and, if this does not suffice, 
three granules of podophyllin or of vera trine every 
evening. The diet should be tonic and analeptic, but 
not stimulating. Sponge-baths, exercise in the open 



416 ELEMENTS OF THERAPEUTICS AKD PRACTICE. 



Dominant. 



Variant. 



air, and rigorous avoidance of all erotic imaginations 
are indispensable hygienic requirements. The hyper- 
secretion of the vulvo-vaginal glands produces in women 
nocturnal pollutions, which may induce great debility. 
Tonic treatment with strychnine and iron, and five 
granules of bromide of camphor at bed- time, will usu- 
ally control this condition. 

j Arseniate of strychnine. 
( Ergotine. 

Cicutine. 

Aconitine. 

Atropine. 

Quassine, piperine. 

Pepsin. 

Hypophosphite of strychnine. 

Sedlitz Chanteaud. 

Arseniate of iron. 

Arseniate of strychnine. 

Phosphoric acid. 

Splenitis. — Splenitis is rarely diagnosticated in the 
acute condition. The vascularity of the organ indicates 
aconitine and ergotine. In most cases splenitis is seen 
in its chronic form as the result of repeated congestions 
of the organ, and due particularly to malarial poisoning. 
The condition of the blood and of the splenic circula- 
tion must be modified, the first by the use of the arseni- 
ates of soda and quinine, and the second by the use of 
ergotine and the arseniate of strychnine. Hsemate- 
mesis, the most important complication of this disease, 
should be treated with three granules of ergotine every 
quarter-hour, or by suitable hypodermic injections of 
the same agent. 



Atony . 

Reflex hyperesthesia 

Vesical hyperemia 
/ Cerebral torpor . 

Loss of appetite . 
I Apepsia 
( Impotence . 

Fecal retention . 

General debility . 



Dominant -S Aconitine > ergotine, arseniate of 

strychnine. 



Variant. 



\ Paludal infection 
( Haematemesis . 



Arseniate of soda, 

quinine. 
Ergotine. 



arseniate of 



Stomatitis, Aphthous (Aphthce). — The nature of 
this disease is still imperfectly known. It may be that 
the ulcerations of the mouth are due to a herpetic erup- 
tion analogous to herpes of the skin, or they may be 
due to infection of the mouth, and sometimes the entire 



ELEMENTS OF DOSIMETRIC PRACTICE. 447 

gastro-intestinal tract, by a parasitic element of un- 
known nature. The discrete variety of aphthae appears 
to be only an attenuated and sporadic form of the con- 
fluent variety, the latter always possessing a certain 
degree of gravity, and sometimes appearing as an epi- 
demic. The sulphide of calcium, whether as an anti- 
herpetic or an antiparasitic agent, should be used in 
preference to other means in all cases of aphthous sto- 
matitis. The granules may be dissolved in the mouth, 
in order to take advantage of their topical effect, unless 
there are some contra- indications to such practice. Un- 
der the latter condition a few granules of salicylate of 
soda or of salicylic acid may be used instead. The sul- 
phide may be administered in doses of one or two gran- 
ules every hour or every two hours. For the fever we 
should give a granule of aconitine every hour ; we will 
also obtain its local action upon the heated and hyper- 
aemic mucous membrane by allowing the granule to dis- 
solve in the mouth. The same effect may be obtained 
by allowing two granules of cocaine to dissolve in the 
mouth every hour, and their anaesthetic effect will fa- 
cilitate secretion or mastication. For the severe pain 
of this disease two granules of codeine or morphine 
may be given every half-hour, either for its topical 
effect or as a general analgesic. Though there may be 
salivation, it is not usually so decided as to be trouble- 
some to the patient. Should it become so we may give 
one granule of hyoscyamine every half-hour. Adyna- 
mia, which is present only when the aphthae are con- 
fluent or secondary, should be treated with two granules 
of sulphate of quinine every hour, or with one of phos- 
phoric acid every two hours. The digestive troubles, 
which almost always precede or accompany the aph- 
thous eruption, should be treated with a small spoonful 
of Sedlitz Chanteaud every morning, and two granules 
of quassine every three hours, together with a few 
swallows of some alkaline mineral water. Should the 
vesicles be opened, they leave ulcerations which usually 



448 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

cicatrize rapidly. In some cases, however, the repara- 
tive process is a slow one, and then it is well to allow 
two granules of tannic acid or iodoform to dissolve in 
the month every two or three honrs. Aphth.se which are 
the result of general diseases indicate primarily the treat- 
ment of those diseases, the cause being thus removed. 



m 1 Domi 

W 
H ( 


nant. Parasitic element 


. Sulphide of calcium. 


/ Fever . 


. Aconitine. 


[ Buccal irritation 


. Cocaine. 


W 


Pain . 


. Codeine. 


^ Variant. ( Salivation . 


. Hyoscyamine. 


"s \ 


Adynamia . 


. Sulphate of strychnine. 




Digestive troubles 


. Quassine, Sedlitz Chanteaud. 




\ Ulcerations 


. Tannic acid. 



Stomatitis, Catarrhal {Simple or Erythematous). 
— The causes of this condition are numerous, but, what- 
ever they be, they must be suppressed, as well to obtain 
a prompt cure as to avoid recurrences, which are always 
liable to occur as long as the cause persists. Usually 
simple idiopathic stomatitis results from the presence 
of an irritating body — for example, dentition, dental 
caries, etc., or from a gastric catarrh which has extend- 
ed to the buccal mucous membrane. Stomatitis has for 
its essential process, therefore, the inflammatory one. 
The dominant should consist of one granule of aconitine 
every two hours, which may be dissolved in the mouth 
in order to utilize its topical effect. Cocaine, by virtue 
of the ansemiating effect which it has upon tissues with 
which it comes in contact, may be equally useful. Three 
granules of it may be given at once, and they should be 
held in the mouth as long as possible, in order to obtain 
the full benefit of their local effect. The drug should 
be given every hour or every two hours, according to 
the severity of the case. Pain and burning in the 
mouth may be relieved by allowing two granules of 
codeine to dissolve slowly in the mouth every half -hour. 
For the fever, which is usually ephemeral and not very 
intense, we should give one granule of aconitine every 
half -hour until defervescence occurs. Should ptyalism 
become excessive, it may be modified by using one gran- 



ELEMENTS OF DOSIMETRIC PRACTICE. 449 

ule of hyoscyamine every three hours. If gastric dis- 
order is present Sedlitz Chanteaud should be used ; it 
may be that the stomatitis is only a manifestation of 
the gastric trouble. 

SIMPLE STOMATITIS. 

Dominant. Inflammatory element .... Aconitine, cocaine. 

fPain Cocaine. 

VAT>TAvrrr J Fever Aconitine. 

variant. < p tyalism Hyoscyamine. 

[ Gastric disorder Sedlitz Chanteaud. 

Stomatitis, Mercurial. — When mercury is elimi- 
nated by the salivary glands, stomatitis of greater or less 
severity results from inflammation of the mucous mem- 
brane after the process has attained a certain degree. 
The most useful means for treatment are those which 
favor the elimination of the mineral by stimulating the 
salivary, urinary, enteric, and cutaneous secretions. 
For this purpose chlorate of potash has a reputation 
which is unquestionable. It should be given in doses 
of four to eight grammes daily, dissolved in two hun- 
dred to three hundred grammes of water, and taken in 
small doses every two hours. Five granules of nitrate 
of pilocarpine four times daily will furnish a suitable 
substitute for the potash salt, if for any reason the latter 
is contra-indicated. Sedlitz should be taken every day 
to increase the elimination by the kidneys and intes- 
tines. The pain may be soothed by using three gran- 
ules of cocaine every half-hour dissolved in the mouth 
or dissolved in a teaspoonful of water before they are 
taken. In addition to its analgesic action, the cocaine 
will rapidly relieve the tissues of their congestion, and 
by this means also the local pain will be relieved. The 
dryness of the mouth will be lessened by dissolving in 
it one granule of aconitine every two hours. Ulcera- 
tions which are slow to cicatrize should be touched 
with perchloride of iron in strong solution, or with the 
solid stick of nitrate of silver. Ptyalism, which is not 
only annoying but a decided source of weakness, may 

29 



450 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

be relieved by using one granule of sulphate of atropine 
or one of hyoscyamine every two hours. The fever, 
which sometimes is very high, may be moderated by 
using one-granule doses of aconitine, the intervals to 
be regulated by the elevation of the temperature. The 
fetidity of the breath may be overcome by chewing 
one or two granules of iodoform every two hours, 
which, in addition to its local antiseptic action, has a 
very useful tendency to facilitate the elimination of the 
mercury. The anorexia and difficulty in masticating 
call for the exclusive use of liquid or semi-solid food. 
Two granules of quassine given four times daily may 
remedy this difficulty. The diarrhoea should not be 
interfered with unless it is compromising the strength 
of the patient ; in that case, two or three granules of 
the hydriodate of morphine should be given every two 
hours. Mercurial stomatitis is followed by a condition 
of profound ansemia, which may be remedied by the use 
of the incitants of vital force and pills of the iodide of 
iron. An essential condition to the success of this 
treatment manifestly consists in a suspension of the 
use of mercury. The mineral may gain access to the 
interior of the body through the skin, the digestive or- 
gans, or the respiratory apparatus. Poisoning may be 
due to one's occupation, to medical treatment, or to 
accident. As a preventive plan we should use mercu- 
rials only in small doses and with occasional intermis- 
sions, the condition of the gums being frequently 
examined so that treatment may be suspended if neces- 
sary, or, at least, so that chlorate of potash may be 
combined with the mercury. The use of the potash 
salt is not without disadvantages, for by concealing 
the first effects of mercurial intoxication it causes us to 
run the risk of passing the stage in which the toxic 
effects are curable, and, besides, deprives us of one of 
the best means which can be used to combat hydrar- 
gyrism. In fact, when the chlorate of potash is impo- 
tent to prevent the manifestation of mercurial stomati- 



ELEMENTS OF DOSIMETRIC PRACTICE. 



451 



tis, its impotence will persist when mercurial poisoning 
has actually occurred. It would seem to be better to 
allow very active substances to produce their proper 
effect at the suitable time rather than to arrest or ob- 
scure its appearance, and so deprive us of that informa- 
tion which is necessary that we may know when to 
suspend their use. 



So 



! Dominant. 



Variant. ( 





( Nitrate of pilocarpine. 


Elimination of 


mercury < Chlorate of potash. 




( Sedlitz Chanteaud. 


I Pain . 


Cocaine. 


Dryness of the mouth . Aconitine. 


Ulcerations . 


j Topical use of perchloride of 
' I iron or nitrate of silver. 


Ptyalism 


Hyoscyamine. 


Fever . 


Aconitine. 


Fetid breath . 


Iodoform. 


Anorexia 


Quassine. 

Hydriodate of morphine. 


Diarrhoea 


y Anaemia 


Iodide of iron. 



Stomatitis, Pultaceous {Maguet, Athrepsia). — 
The nature of this disease is now well known. It is 
due to the growth of Oidium albicans in a medium 
which is favorable to its development. One of the 
necessary conditions to its culture is a medium which 
has an acid reaction, and, as the buccal mucous mem- 
brane in badly nourished children has an acid reaction, 
the same being true with all persons whose digestive 
functions and nutrition in general are not up to the 
normal standard, muguet is developed primarily in 
children at the breast, and secondarily in adults who are 
more or less cachectic. In most cases this form of 
stomatitis has a grave prognosis, for it indicates that 
there is a decided disturbance of nutrition in those who 
are its subjects. It is believed that O'idium albicans 
is transmitted only by contact, which is an argument 
in favor of the plan of treatment which is here advised. 
There are two fundamental indications in this disease : 
one is suggested by the conditions of receptivity, the 
principal of which is a diminution in the vitality ; the 
other is responsible to the parasitic character of the 
morbific agent, which compels us to have recourse to the 



452 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

parasiticides. In the first case, we should give, to small 
children, one granule of brucine three to five times 
daily ; to adults, two granules of the arseniate of strych- 
nine three to five times daily. After taking the 
granules, one should take a swallow of some alkaline 
mineral water, or they may be dissolved in such a 
medium before being taken if the age of the child indi- 
cates that they be taken in solution. The second indi- 
cation should be satisfied with sulphide of calcium as 
a topical antiparasitic agent, three to five granules be- 
ing taken after meals, and oftener if necessary, dis- 
solved in an alkaline water or in the oil of sweet 
almonds. For adults, two granules may be given from 
time to time, being either chewed or dissolved in the 
mouth. This remedy may be taken without hesitation, 
and it will assist the local treatment. Muguet of the 
oesophagus, stomach, and intestine especially will be 
benefited by this treatment. Salicylic acid and the 
salicylates may be used instead of the sulphide of cal- 
cium, but the latter is to be preferred. The buccal 
catarrh which precedes the appearance of the pultaceous 
patches should be treated, from its beginning, with half 
a granule of aconitine (for infants at the breast) every 
two or three hours. Aconitine may also be given in 
solution in order to utilize its local action. The nitrate 
of pilocarpine, which is eliminated by the salivary 
glands, is also a very useful remedy, for it has a favor- 
able influence upon the cause of the disease, and facili- 
tates the healing of the ulcerated patches. One granule 
should be given every two hours. Irritation and pain 
in the mouth, which often act as an obstacle to suc- 
tion and to the swallowing of the milk, may be relieved 
by two granules of cocaine every two hours, dissolved 
in a spoonful of water. Yomiting and diarrhoea will 
rapidly weaken children, and thus increase the morbid 
receptivity. Brucine and codeine are the most suitable 
agents for this condition, especially if the children are 
naturally robust, one granule of each being given every 



ELEMENTS OF DOSIMETRIC PRACTICE. 453 

three hours. If the children are feeble, two granules 
of the salicylate of soda or of iron may be given in 
preference every three hours. The choleriform condi- 
tion, which is characterized by fluidity and great 
frequency of the stools, by rapid emaciation and chilli- 
ness of the surface of the body, should be rigorously 
treated with the hydrochl orate of morphine, the doses 
being carefully regulated by the age of the patients. 
For children under two months of age, half a granule 
may be given every two hours ; for children of two 
years or under, one granule every three hours. Circum- 
anal erythema, which is caused and aggravated by the 
alvine evacuations, may be relieved by applications of 
vaseline or a solution of tannic acid, five granules being 
dissolved in a little water, and thus applied to the irri- 
tated surface. Cutaneous ulcerations indicate a grave 
condition with respect to nutrition and assimilation, 
and depend less upon muguet than upon an abnormal 
condition which Parrot has termed atlirepsia. For 
this condition we should give tonics internally, and ap- 
ply iodoform and bismuth in equal parts externally. 
The hypothermia which is the ordinary accompaniment 
of choleriform diarrhoea, but which may also occur 
alone, should be treated with one granule of phosphoric 
acid every two hours, or with external means for excit- 
ing peripheral vitality, such as warm baths, sinapisms, 
etc. Ordinary hygienic precautions must be thoroughly 
carried out, and particularly must cleanliness of the 
mouth be insisted upon. 

Oidium albicans . . j Su / a P t ^ de ° f Calcium ' Salicy - 



g«5 

oh 

Eh 

Eh S 

£° 



f Dominant. 



Variant. / 



Lowered vitality . . j B ™ e ' arseniate of strych- 

I Buccal catarrh . . i Aconitine, nitrate of pilocar- 
( pme. 
Buccal irritation . . Cocaine. 
Vomiting and diarrhoea Brucine, codeine. 
Choleriform condition . Hydrochlorate of morphine. 
Erythema around the j Tannic acid . 

anus . . . . ( 
Cutaneous ulcerations . Iodoform. 
V Hypothermia . . Phosphoric acid. 



454: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Stomatitis, Ulcero - membranous (Stomacace, 
Noma, Gangrenous Stomatitis, Pseudo-membranous 
Stomatitis, Ulcerative Stomatitis, Diphtheritic Stoma- 
titis). — Ulcerative stomatitis, by its epidemic and con- 
tagious properties, by its prodromic signs and well- 
defined localization, must be regarded as an infectious 
disease, the agent of which is still undiscovered. The 
infectious element must be combated with two gran- 
ules of the sulphide of calcium every half -hour dis- 
solved in the mouth, unless the patient's repugnance 
to the disagreeable taste can not be overcome. If the 
fever is high, a granule of aconitine may be given every 
hour, combined with arseniate of strychnine, that the 
defervescent effect may not be too depressing. If the 
fever is of slight intensity, and is attended with remis- 
sions, three granules of the salicylate of quinine every 
half -hour should be preferred. The pain in the cheeks, 
which is sometimes severe, may be quieted with three 
granules of codeine in solution every two hours. The 
fetid condition of the breath, which is sometimes sug- 
gestive of gangrene, may be modified by chewing two 
granules of iodoform every hour. One granule of atro- 
pine every three hours will relieve the ptyalism. 
Adenopathy pertaining to the submaxillary and parot- 
id glands shows the infectious character of the buccal 
lesion, and indicates in the one case a favorable, in 
another an unfavorable progress of the disease. Should 
it be terminated by suppuration, iodoform may be 
given to hasten the resolution of the glandular engorge- 
ment. Ulcerations should be treated locally or inter- 
nally with chlorate of potash, the influence of which 
upon the process of cicatrization is decided. Teaspoon- 
ful doses may be given of a solution of four to eight 
grammes in two hundred grammes of water. For the 
anorexia three granules of quassine may be given three 
or four times daily. The alimentation of the patient 
must be reparative in character, in order to anticipate 
and prevent adynamia, which often occurs in connec- 



ELEMENTS OF DOSIMETRIC PRACTICE. 



455 



Infectious element 


Sulphide of calcium. 


Fever . 


j Aconitine, salicylate of qui- 
' \ nine. 
Codeine. 


Buccal pain . 


Fetid breath 


Iodoform. 


Ptyalism 
Adenopathy . 


Sulphate of atropine. 


Iodoform. 


Ulcerations . 


( Chlorate of potash. 
' ( Nitrate of pilocarpine. 


Anorexia 


Quassine. 


k Adynamia . 


Arseniate of strychnine. 



tion with this disea.se. When the strength is begin- 
ning to fail, or even from the beginning of the disease, 
two granules of the hypophosphite or the arseniate of 
strychnine should be given every three hours. Proper 
hygienic regulations play an important part in effecting 
a en re of this disease. Pure air and isolation of the 
patients are indispensable to rapid and certain recov- 
ery. 

Jc*m I "Dominant. 

la 

i o 
nH \ Variant. ( 

& m 
Km 
2^ 
&K 

Syphilis. — To some writers syphilis is a disease the 
ultimate cause of which is unknown ; to others, the 
disease is due to an infection of the organism by a mi- 
crobe (coccus), which has been carefully investigated 
by Marcus and Tornery. It is an unquestionable fact, 
however, that the cause of syphilis may be treated suc- 
cessfully with mercury. Therapeutics, convinced of 
the efficiency of the mercurials for neutralizing the 
syphilitic virus, is as efficient as it is empirical in its 
action, or, looking at the matter from another stand- 
point, it conforms itself to the course which is imposed 
upon it by the existence of a particular microbe. The 
dominant of the treatment is, therefore, clearly indi- 
cated. In every period of the disease mercury is use- 
ful, and constitutes the basis of the best plans of treat- 
ment. In tertiary syphilis, however, iodine seems to 
be preferable, either because it gives new activity to 
the mercury which has already been introduced into 
the system, or because, by actively modifying the nu- 
trition, it causes a morphological regeneration of the 
diseased tissues, or because it has in its turn a particu- 
lar action upon the specific infection at this period in 



456 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

the history of the microbes. Various methods of intro- 
ducing mercury into the system have been tried. The 
endermic and the dermo-pulmonary methods should be 
rejected, because they do not admit of graduation of 
the doses, which is an important point in the treat- 
ment. The only methods which should be accepted 
are those in which the medicaments are administered 
by the mouth or hypodermically. The first is the 
milder, and is generally the more acceptable to patients. 
It should be preferred except in cases in which the di- 
gestive organs will not tolerate it, or the urgency of 
the case demands the use of the subcutaneous method. 
Dosimetry makes use of three compounds of mercury 
— calomel, the protiodide, and the biniodide, the last 
two being used in almost all cases. Iodoform, either 
alone or combined with one of these salts, will be found 
very serviceable in the tertiary period. Mercurial treat- 
ment should be commenced as soon as one is certain 
that syphilitic infection has occurred, conclusive evi- 
dence being furnished by a chancre or the specific rose- 
ola. We should at once give the protiodide in doses 
of five granules two or three times daily. They should 
be taken with the meals or in milk, to prevent disturb- 
ance of the digestive organs, in all cases in which a 
prompt modification of the disease is demanded, or in 
which the patient, too much influenced by the primary 
lesions, has not the patience to await the effects of long- 
continued treatment. In other cases smaller doses may 
be given, the treatment being continued a long time ; 
two granules three times daily will suffice. Should 
the protiodide cause gastro-intestinal disturbance, it 
may be replaced by the biniodide in similar doses. 
Should the intolerance persist, two granules of the 
hydrochlorate of morphine or three of codeine may be 
given with each dose of mercury. This plan of treat- 
ment will generally suffice for all cases of syphilis. 
The difficulty is in continuing it a sufficiently long 
period of time. The author objects to interruptions in 



ELEMENTS OF DOSIMETRIC PRACTICE. 457 

the treatment, believing that it is better to continue 
until a complete cure has been obtained, unless one is 
compelled to discontinue for a while to avoid the physi- 
ological effect of the mercury. Iodoform should be 
given in doses of three to ten granules three times daily 
in those cases of tertiary syphilis in which mercury is 
inappropriate. If iodoform can not be given continu- 
ously, it may be alternated with iodide of potassium in 
solution, taken in milk. The solution should contain : 

5 Aquse destil 250 grammes. 

Potass, iod 15 " 

A large spoonful may be taken at suitable intervals in 
a swallow of milk, the quantity of the solution being 
gradually increased to the limit of toleration. Among 
the many accidents accompanying syphilis, a few may 
be mentioned which call for particular treatment in 
addition to the dominant. Syphilitic iritis is frequent- 
ly accompanied with photophobia and violent peri- 
orbital pains, which are a source of great distress to 
the patient. For this symptom a granule of daturine 
should be given every hour until relief is obtained. 
Even should the iritis be unaccompanied by such disa- 
greeable symptoms, its cure may be hastened by add- 
ing one or two granules of hyoscyamine to each dose of 
the mercurials. The osteocopic pains must be treated 
with iodoform and iodide of potassium, and, for the vari- 
ant, with three granules of the hydriodate of morphine 
every half -hour during their continuance. The disap- 
pearance of the papules and the ulcerations may be 
hastened by local applications of Yan Swieten's solu- 
tion, or of a solution of ten granules of the protiodide 
in a little water. Buboes should be treated during the 
febrile stage by defervescents. During the stage of 
suppuration they may be dressed with glycerole of 
phenic acid ; while the patient may take for internal 
treatment two granules of arseniate of soda and two of 
iodoform four times daily. The infecting chancre 
should be dressed with iodoformized ether, 5 : 100, es- 



458 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

pecially if it shows any irregularities of contour. If 
the bottom of the ulcerated surface is regular, iodoform 
or calomel in powder may be applied. The soft chan- 
cre requires scrupulous cleanliness, and, if cicatrization 
is delayed, tannic acid or sulphide of calcium in pow- 
dered form. Anaemia, which is of frequent occurrence 
in syphilitic patients, should be treated with quassine 
and the arseniate of strychnine. The same treatment 
would be appropriate if the chancre were phagedenic ; 
but this form usually occurs only in broken-down con- 
stitutions, in which the suffering has been of long dura- 
tion or the treatment has been unsuited to the case. 
Cerebral syphilis requires a particular form of treat- 
ment on account of its gravity and the rapidity with 
which its phenomena are developed. Hypodermic 
medication must be used in this form of the disease, 
the injections being made deeply into the cellular 
tissue. The following formula should be used : 

9 Peptoni (Catillon) in pulv 0*30 gramme. 

Ammonii chlor. puri 0*30 " 

Hydrarg. bichlor 0*20 " 

Glycerinse 5*00 grammes. 

Aquae destil 15-00 " 

Each injection should contain ten milligrammes of the 
mercurial salt. 

If for any reason this method can not be used, three 
granules of the protiodide should be given every half- 
hour, the interval being gradually increased as an effect 
is produced, and the treatment being continued until 
all danger is over. All the differential characteristics 
of the lesions of this disease, which can distinguish 
them from similar lesions in other diseases, should be 
carefully studied by the physician. They are often 
very obscure, and their true character may only be 
discovered by their destructive action, or their resist- 
ance to all forms of treatment until the specific one is 
employed. In women the primary infection may be 
kept secret, or it may be that inoculation has been so 



ELEMENTS OF DOSIMETRIC PRACTICE. 



459 



slowly followed by constitutional disturbance that seri- 
ous disease has not been suspected. In some cases the 
disease is associated with disorders of the nervous sys- 
tem, and in others by other phenomena ; in all cases, 
however, the disease does not yield until the treatment 
which is appropriate to this disease is used. 

t t -f u v~ / t? i- \ Protiodide and biniodide 

• Infection by j Recent . . j f me 

(Dominant. - the coccus j . , ,. ! Biniodide hi mercnrv 

of syphilis ( Long standing } Rnd iodoform< 

I Intolerance of the digestive j Codeine, hydrochlorate 

organs 

f Photophobia . 

Iritis J ^ eural g ia 



Variant. ( 



1 Myosia . 

[Conjunctivitis 

Osteocopic pains, nocturnal 

paroxysms, with insomnia . 

( Fever . 
Adenitis . -| 

( Suppuration . 



Cerebral syphilis 



\ Anemia 



1 of morphine. 
Daturine. 

Valerianate of atropine. 
Hyoscyamine. 
Aconitine. 

I Hydriodate of morphine. 

j Aconitine, hydroferro- 
( cyanate of quinine. 
) Arseniate of soda. 
} Iodoform. 
Active internal treat- 
ment. 
Hypodermic injections of 
the ammoniacal pep- 
tonate of mercury. 
\ Quassine, arseniate of 
I strychnine. 

Tetanus, — The lesion of innervation by which the 
reflex excitability of the cord is increased, and which 
is known in pathology under the name of tetanus, is 
not yet sufficiently understood as to its pathogenesis to 
enable us to thoroughly understand its nature. The 
study of its various causes only enables us to arrive at 
the conclusion before mentioned, and upon that we 
shall base the dominant indication, which is to soothe 
and diminish the irritability of the cord, the center 
which receives the particular irritation transmitted by 
the injured nerve, and from which the impulses to the 
convulsions that are characteristic of tetanus proceed. 
If the receptive condition of the central organ could be 
abolished or sufficiently repressed, the reflex contrac- 
tions would cease, and the disease would then be re- 
duced to the morbid work localized in the injured pe- 
ripheral nerve. If we are not able to cure the disease, 



460 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

we can at least arrest its progress and eliminate the 
principal symptoms. In attempting to accomplish this 
end, we should use persistently four granules of the 
bromide of camphor every hour, or every half-hour if 
the case is very severe or very rebellious, adding there- 
to the medicaments which are indicated by the variant. 
Thus, when the pain becomes very severe, whether it 
be due to the contractions or be located in the injured 
nerve, two granules of cicutine or the hydrobromate of 
morphine should be added every half -hour. Violence 
and frequent repetition of the convulsions should be re- 
pressed with antispasmodics and musculo-paralyzants. 
Two granules of hyoscyamine, croton chloral, and vera- 
trine should be given every hour until the desired effect 
is obtained. Yeratrine will also modify the excess of 
heat, and hyoscyamine will overcome the constipation. 
For the hyperthermia we should give one granule of 
aconitine every hour as long as the temperature is not 
above 39° C, and every half-hour when it exceeds that 
point. Congestion should be treated by the same 
means ; when it is due to fatigue or ataxia of the heart, 
a granule of digitaline should be added every hour 
until the pulse becomes regular. Paralysis, the most 
frequent forms of which are those which affect the 
bladder and rectum, should be treated with one granule 
of the arseniate of strychnine and one of phosphoric 
acid every two hours. For constipation, which is some- 
times very obstinate, live granules of podophyllin 
should be given with a teaspoonful of Sedlitz Chan- 
teaud three or four times at intervals of half an hour. 
In some cases the paroxysms are more or less periodic 
in character, indicating three granules of the hydrobro- 
mate of quinine every hour. If the condition of the 
patient is such that the regular administration of the 
medicaments is not possible, we must seek to soothe 
him by such means as will permit the application of 
the treatment. The prolonged use of electricity and 
the employment of enemata of hydrate of chloral may 



ELEMENTS OF DOSIMETRIC PRACTICE. 



461 



be of service in inducing a remission, advantage of 
which must be at once taken by beginning a systematic 
attack upon this terrible disease. 

j Exaggeration of nerve 
I irritability 



^ / 
En 

Eh 



Dominant. 



^Variant. { 



Pain 

Convulsions . 
Hyperthermia 
Congestion . 

Paralysis 

Constipation 
Intermittence 



of 



the ) 



Bromide of camphor. 

j Hydrobromate of morphine. 
( Cicutine. 

Hyoscyamine, croton chloral. 
) Aconitine, veratrine, digita- 
\ line. 

Arseniate of strychnine, phos- 
phoric acid. 

Sedlitz Chanteaud. podophyllum 



Hydrobromate of quinine. 



* paroxysms 

Tuberculosis. — See Tuberculous Disease (under 
Disease). 

Ulcer, Gastric. — Ulcer of the stomach may be due 
to different causes, all of which are reducible to atony 
of the organ or to a want of nutritive force. At the 
beginning, such ulcerations present nothing peculiar ; 
subsequently they become round and perforating, this 
peculiarity being given to them, according to many 
pathologists, by the action of the gastric juice, which 
corrodes the submucous tissues by means of its digest- 
ive properties. The dominant will consist, therefore, 
in augmenting the vitality of the mucous membrane, on 
the one hand, by means of the excito-motors, one or 
two granules of strychnine or two or three of brucine 
being given three times daily ; and in neutralizing, on 
the other hand, the digesting action of the gastric 
juice. Unfortunately, it is not easy to satisfy this sec- 
ond indication. Physiology has not yet discovered 
any substance which can prevent the action of the gas- 
tric fluid, and we know that it covers the mucous mem- 
brane to a greater or less degree, even if there is no 
food in the stomach to excite its secretion, as after a 
prolonged fast. The alkalies produce slight results, 
and only when taken in large doses do they modify 
the composition of the gastric juice. This is an ob- 
stacle to their use, for patients who suffer from this 
disease are usually in a state of profound anaemia, 



462 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

which is a contra-indication to the extensive use of 
alkalies. We are therefore restricted to a limited 
diet — for example, a diet of milk — food being taken 
by the mouth only at long intervals. Such a plan of 
alimentation may be supplemented by means of rectal 
enemata of peptone if they can be tolerated. The re- 
strictive action of atropine upon the secretions may be 
used to diminish the secretion of gastric juice, this 
agent responding also to other important indications of 
the variant. For example, it will relieve epigastralgia, 
the pathogenesis of which is uncertain, but which 
seems to be due principally to the irritant action of 
food upon nerves which have been laid bare in the 
course of the ulcerative process, and to their lengthen- 
ing and compression in consequence of the peristaltic 
movements of the stomach. Three granules of the hy- 
drochlorate of morphine every quarter-hour, associated 
or alternated with one of the sulphate of atropine every 
half -hour, will usually relieve the severity of the pains. 
These anodynes should be frequently changed in order 
to retain their usefulness. It is important that the pa- 
tient be relieved, because the frequency, the duration, 
and the intensity of the gastralgia are causes which 
concur in inducing cachexia. In some cases the ab- 
sence of pain implies absence of vomiting as well, and 
in these the food which is taken does not produce an 
excessive degree of distress. As alternates to mor- 
phine, one may give three granules of cocaine, three of 
codeine, or two of cicutine every half -hour until relief 
is obtained. Vomiting may also be treated by the 
means which have just been referred to. Gastrorrhagia 
or hsematemesis may be treated with five granules of 
ergotine dissolved in a little cold water every quarter- 
hour, or hypodermically with a ten-per-cent. watery so- 
lution of the same agent. Melsena of a temporary char- 
acter is evidence of gastrorrhagia which has already been 
brought under control, and therefore does not require 
the use of haemostatics ; but, if it should be repeated, 



ELEMENTS OF DOSIMETRIC PRACTICE. 463 

ergotine must be given for several days, for we are 
ignorant of the precise cause for the extravasation of 
blood, and, besides, such losses are of serious impor- 
tance to the patient in his debilitated condition. Five 
granules of ergotine should be given, therefore, at in- 
tervals of three hours. The anaemia, which is almost 
always present when the disease is far enough advanced 
to be diagnosticated, on account of the changes in the 
digestive apparatus, should be treated with the lactate, 
the arseniate, or the perchloride of iron. Quassine may 
be indicated if it is necessary to stimulate the appetite, 
or to gently incite the stomach to contractility. Consti- 
pation, which adds to the discomfort of the patient, 
and may also induce attacks of gastralgia, should be 
treated with three to five granules of podophyllin 
every evening, or ten of euonymine once or twice 
daily. Hygienic precautions must also be enforced for 
a Ions: time. 



^^--Iv^x f ato„ y ga : tric 

2 j / Epigastralgia 

ta \ f Vomiting of food 



juice . Alkalies. 

. Strychnine. 



Hasmatemesis 

Variant. ( Anaemia 

Melaena 

Digestive disorders 



Morphine, hyoscyamine. 

Morphine, atropine. 

Ergotine, ice. 

Salts of iron. 

Ergotine. 

Quassine. 

Podophyllin. 



^ \ Constipation 

Urethritis and Vaginitis. — Urethritis may be 
simple or virulent. Simple urethritis is established in 
the same way as any other inflammation of mucous 
membrane, with this difference, that it lasts longer on 
account of the repeated aggravation which is due to the 
passage of the urine. It may be treated at the begin- 
ning like any other catarrhal inflammation, with aconi- 
tine in doses which should be governed by the violence 
of the inflammatory process and the febrile state. The 
character of the urine must be changed in order that it 
may offer the slightest possible hindrance to the cure of 
the disease. To accomplish this end three granules of 
benzoate of soda or of benzoic acid should be taken 
after each micturition, and alkaline waters should be 



464: ELEMENTS OF THERAPEUTICS AND PRACTICE. 

used for ordinary drinking purposes. The use of ex- 
ternal emollients must not be neglected in the first or 
acute stage of the disease. Painful erections should be 
treated with the bromide of camphor every half-hour, 
and spasm at the neck of the bladder with one granule 
of hyoscyamine every two hours, or oftener if there is 
true dysuria. After the first period, if the blennorrhagia 
continues, three granules of cubebine should be given 
after each micturition, and in chronic cases two gran- 
ules of piperine four times daily. Arbutine and helenine 
are also useful means for relieving the blennorrhagic 
discharge. Either of them should be given in doses of 
three to 1\nq granules three to five times daily. With 
persons of lymphatic diathesis urethritis may easily 
become chronic and rebellious to all direct treatment. 
In order to obtain a result promptly in such cases the 
general nutrition must be modified by means of an ana- 
leptic diet and the prolonged use of two granules each 
of arseniate of iron and iodoform, three times daily. 
Virulent urethritis is due to contact with a parasite 
which bears the name of gonococcus. It should be at- 
tacked locally with injections of permanganate of pot- 
ash (one half gramme to one gramme in one hundred 
grammes of water), or with three granules of sulphide 
of calcium (repeated with sufficient frequency), tritu- 
rated in the fluid portion of each injection. Chronic 
gonorrhoea should be treated locally with injections of 
lactate of quinine (1 : 100), or with tannic acid in solu- 
tion, three granules being dissolved for each injection. 
Subacute or chronic vaginitis should be treated with 
the same means, the local treatment being slightly 
varied. Tampons of charpie or of cotton- wool should 
be introduced into the vagina, soaked with one of the 
following solutions, viz.: 

5 Chloral hydrate 1 gramme. 

Aquae destil 100 grammes. 

5- Resorcin 1 gramme. 

Aquae destil 100 grammes. 



ELEMENTS OF DOSIMETRIC PRACTICE. 



465 



Ijfc Tannin 6 grammes. 

Glycerinae 100 grammes. 

The doses of these agents must be gradually increased 
until the disease is brought under control, and then as 
gradually diminished to prevent recurrence. 

BLENNORRHAGIA FROM URETHRITIS OR VAGINITIS. 



Simple 



Acute 



Subacute 

or 
Chronic 



Dominant 
Variant 



Fever . 

Erections 
Irritating 



Dominant 



f Spasmodic dysuria 

Variant J D y suria from clos " 
vanant < mg of the canal . 

[_ Lymphatic diathesis 
Virulent. 



Aconitine. 

Aconitine. 

Bromide of camphor. 

Benzoates and alkalies. 

Cubebine, piperine, arbutine, 

helenine. 
Hyoscyamine. 

Elastic sounds. 

Arseniate of iron, iodoform. 



f Dominant 



Acute 



I Variant 



Subacute ( Dominant 

or -j 
Chronic ( Variant . 



C Injections of permanganate of 
J potash. 

* 1 Injections of sulphide of cal- 
[_ cium. 
{ The same variant as in simple 

' ( acute blennorrhagia. 

j Injections of lactate of quinine. 
' ( Injections of tannic acid. 

j The same as the variant in sim- 

* ( pie chronic blennorrhagia. 

Uterus, Cancer of the.— When degeneration of 
the tissue of the neck or the body of the uterus is 
established, not much can be done in the way of restor- 
ing them to their normal condition. While we under- 
stand that a cure is possible, we are ignorant of the 
means by which it may be obtained. We should there- 
fore concentrate our attention in order to find a suitable 
plan of preventive treatment for women who are pre- 
disposed, whether by hereditary influence or by a me- 
tritis of long duration, to this disease. Means which 
favor assimilation, which make the blood more plastic, 
and the functions of the nervous system more perfect 
in their action, should be perseveringly employed to 
accomplish this end with any and all in whom a tend- 
ency to this disease is suspected. Arseniate of soda, 
arseniate of strychnine, iodoform, and ergotine are the 

30 



4:66 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

agents which must be introduced into the body in order 
to modify the diseased tissues, and the vitality which 
gives them their abnormal existence. Hydrastine has 
seemed to be effective in delaying the progress of de- 
generation in some cases, when given for long periods 
of time. It may be used in doses of four granules, 
three times daily, combined with or alternated with 
iodoform and arseniate of soda. The haemorrhages 
must be controlled by using three granules of ergotine 
every quarter-hour, or by applications of dilute per- 
chloride of iron. The pain, which is sometimes intol- 
erable, may be modified by using two granules of cicu- 
tine hourly, or two of gelsemine every half-hour, or two 
of hydrochlorate of morphine every quarter-hour. It 
is well to change the narcotic from time to time, in 
order to avoid multiplying the doses. For the anorexia 
two or three granules of quassine or piperine should be 
given before meals. The fetid character of the discharges 
may be overcome by injections of permanganate of pot- 
ash (20 : 500). For the diarrhoea three granules of bru- 
cine and three of the hydrochlorate of morphine should 
be given every two or three hours. Similar doses of 
tannic acid may be substituted for the alkaloids, if they 
are required at very short intervals. In the first period 
of the disease some results may be expected from this 
treatment, but after it has reached a certain stage of 
development we must be contented with simply a pal- 
liative treatment. 



fe^ 




' Cancerous degeneration 


Hydrastine. 


62 c -1 / 


' Dominant. ■ 


Dyscrasic state of 
secretions . 


the 


[• Iodoform, arseniate of soda. 




Hypertrophy 




Ergotine. 


O^ 




I Haemorrhage 




Ergotine. 


5 25 




Pain 




Gelsemine, cicutine. 


EH 


i Variant. / 


Anorexia 




Quassine. 


1 Fetid discharges . 




Disinfectant injections. 






, Diarrhoea 




\ Brucine, morphine, tannic 
} acid. 



Vaginitis. — See Urethritis. 

Variola. — " Everything has been said in respect to 
variola, and yet everything still remains to be said. In 



ELEMENTS OF DOSIMETRIC PRACTICE. 467 

fact, with regard to its etiology, our ignorance is com- 
plete. Are bacteria or mbriones its cause or its effect ? 
That is the question." With the foregoing words Burg- 
graeve begins some observations upon an article on 
variola, written by Hahn, of Marseilles. The great 
pathogenic and therapeutic question of the day con- 
cerns variola. Few are the diseases for which we pos- 
sess certain and effective remedies ; some of them are 
treated by us with agents, the action of which is un- 
known to us ; in others the treatment is a rational one, 
and is founded upon clear and well-defined pathogenic 
indications. If, therefore, we subtract those diseases 
in which the treatment is of a specific character, the 
diseases which remain can be treated in only two ways 
— that is, by having regard either to their etiological 
or their symptomatic indications. Dosimetry fre- 
quently makes use of symptomatic therapeutics in the 
absence of the pathogenic variety, but its aim is always 
to seek to replace the first by the second, which follows 
a surer and a clearer way. The treatment of variola 
up to the present time has been symptomatic rather 
than really pathogenic, because the pathogenesis is still 
deficient as to the clearness which is necessary to fur- 
nish unquestionable indications. It is not designed in 
this place to presume to solve the doubts of the pa- 
thologists in regard to the nature of variola, nor to 
justify the opinion of Hallier or Lebert by individual 
microscopical investigations, and give an opinion as to 
the vegetable or animal nature of the microbes to which 
the origin of the contagion is attributed. If, however, 
we compare the results obtained from the culture and 
inoculation of microbes with the phenomena which 
occur in variolous patients, we are compelled to admit 
the analogy which exists between these two classes of 
facts, and, supporting ourselves upon the principles of 
experimental philosophy, so admirably demonstrated 
by the immortal Claude Bernard, to admit, in addition, 
the parasitic nature of the primordial cause of the dis- 



468 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

ease, for winch we shall seek to establish in this chap- 
ter a rational plan of treatment. The pathogenic indi- 
cation rests, therefore, in the choice of an agent which 
is able either to destroy the micrococcus of the disease, 
or to furnish to or remove from the organism a sub- 
stance which will render it unsuitable for the culture 
of bacteria or the germination of inoculated spores. 
Besides, as the evidence of contagion is manifest only 
after the development of the first germs, it is necessary 
to find an agent which is sufficiently diffusible to pene- 
trate all the elements of the body, and attack each in- 
dividual microbe. The compounds of sulphur, which 
have a well-known antizymotic power and are very 
diffusible, are certainly the most appropriate agents 
for combating the invasion of the bacteria of variola. 
The results obtained by Fontaine in the treatment of 
diphtheria, and by Henrique Gabaldon in the treatment 
of aphthous stomatitis, have suggested the idea of using 
sulphide of calcium as the dominant in variola. The 
great power of this agent as a bactericide can not be 
denied, and it was introduced, or, at any rate, popular- 
ized, by the adherents of dosimetry. The results which 
the author has obtained have been so satisfactory that 
he thinks he is justified in using them as an argument 
in favor of the parasitic nature of the efficient cause of 
this disease. Naturam morborum ostendit curatio 
(Treatment reveals the nature of diseases). Up to the 
present time, alike in the most severe and the most 
benign cases, the physician is compelled to admit the 
impotence of his means of treatment. The belief in 
fatalism has not yet disappeared from the field of medi- 
cal science. It is still believed that it is impossible to 
diminish by a single day the prearranged duration of 
diseases. Patients with variola are told that they must 
traverse a certain number of periods of so many days 
each, and therapeutics thus seems to sustain the popu- 
lar proverb which affirms that there is scarcely a day's 
difference between the duration of a disease which is 



ELEMENTS OF DOSIMETRIC PRACTICE. 469 

treated and one which is left to itself. And one mnst 
not say that we can at least act npon the complications 
of diseases, and bring them to a happy end, even if we 
can not intervene in respect to duration. There is no 
proof of this, and such a capability by the side of the 
incapability referred to would be a plain absurdity. 
He who can guide a runaway horse ought also to be 
able to check and stop him. The author disagrees en- 
tirely with this profession of medical nihilism, which 
-first gives birth to and then sustains an irrational and 
routine system of therapeutics. Now that science has 
other means, and is making other discoveries, we are 
especially happy in announcing the good news. Our 
colleagues are supplicated to abandon the unhappy 
skepticism to which they have hitherto been con- 
demned, and our patients are assured that therapeutics 
has ceased to be a myth ; for them, also, the days of 
fatalism have disappeared. The following remarks will 
have particular reference to the treatment of variola. 
The empirical and exciting remedies gave way to those 
which, it is true, were inoffensive, but they were also 
useless. Preparations of quinquina, opium, and alco- 
hol were replaced by infusions of violets, of linden, and 
of saffron. It is difficult to say why the latter should 
be preferred to the former. Both varieties, used with- 
out confidence and without reason, have no other object 
but to amuse the imagination of the patient and calm 
the impatience of his family, and respond neither to 
any scientific indication nor to the obligations of con- 
science on the part of the physician. And thus one 
goes from one experiment to another, from a fruitless 
attempt to a discouraging disillusion, and then to 
skepticism, all of which is not only a crime for the 
present of the medical profession, but is also a peril for 
its future. Faith, like incredulity, is contagious, and, 
when this incredulity penetrates the public mind, it 
takes the name of science, which is able to struggle 
against charlatanism only when there remains to it, in 



470 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

default of charity, a little faith and a glimmering of 
hope. The certainty of success, which the author be- 
lieves is possible by interfering in the course of variola 
with certain medicaments until the disease is aborted, 
makes it a duty with him to insist minutely upon the 
way in which the dominant should be applied. In order 
that a plan of treatment may be perfect, it must fulfill 
two conditions, viz., it must be rational and it must be 
effective. Common sense will decide as to the first, 
and the facts in the case will demonstrate the second. 
To decide whether a therapeutic application is rational, 
it is necessary to know, first, the nature of the disease ; 
second, the natural properties or the physiological ef- 
fects of the remedy which is being used. We ought 
therefore to have clearly in mind the essential cause of 
variola, and the effects produced upon it and upon the 
organism by the sulphide of calcium, a substance to 
which the preference which it deserves is now accord- 
ed, after various experiments of a comparative nature. 
Variola is a disease which is caused by very minute 
organisms or their germs, which are free in the atmos- 
phere, and circulate around man in great numbers. 
Man is exposed to infection from them, as they are in 
contact with his epidermis, by absorbing them with his 
food or with the air which he respires. Whether these 
organisms traverse the intact integument or take ad- 
vantage of a solution of continuity to penetrate the 
tissues, it is certain that in order to multiply they must 
have particular conditions of temperature and chemical 
combination, in default of which they die. The union 
of these conditions which are essential to the life and 
propagation of the parasites of variola is termed recep- 
tivity. Just as certain seeds will germinate only in 
the presence of certain meteorological conditions and 
in certain soils, so organic receptivity is necessary in 
order that the introduction of morbific germs be fol- 
lowed by disease. This explanation furnishes the key 
to the contagious and infectious properties of disease, 



ELEMENTS OF DOSIMETRIC PRACTICE. 471 

and also shows us why everybody is not attacked by 
the disease, why vaccine is useful, and why the disease 
seldom attacks the same person twice. Vaccine and 
variola, by changing the fluids of the body more or less 
fundamentally, render it less susceptible to a second 
attack, the first parasites having absorbed certain ele- 
ments which furnish their natural alimentation. This 
is the reason why certain plants can not be cultivated 
successfully several years in succession in the same 
soil, the first cultures having absorbed all or nearly all 
the existing material which is essential to their germi- 
nation and development. The germ having been in- 
troduced into an organism in which it finds a medium 
suitable for its existence, quickly multiplies with the 
exuberance which is peculiar to all these minute beings, 
which seem to seek in their marvelous facility in repro- 
duction a compensation proportional to the smallness 
of their size. It is during this period of incubation 
that it would be easy to eliminate the disease, if we 
had the means for destroying all the ovules. But as 
the organism does not complain, and gives no indica- 
tion of what is going on in the depths of its tissues, 
and, moreover, as it seems to be easier to poison a 
parasite than to deprive its eggs of the power of repro- 
duction by the use of suitable agents, it would appear 
to be neither practical nor logical to advise a preserva- 
tive means of treatment. When the period of incuba- 
tion is ended, the morbid scene really begins. The 
parasites, millions of which are at work in the interior 
of the organism, naturally excite an active irritation in 
the cells, which irritation is manifested by fever, pains 
in the head, and other symptoms less constant in their 
manifestation. This is the period of invasion. These 
microscopic organisms or microphytes, eager for air 
and light, accumulate near the surface of the body, 
thus determining certain changes which mark the be- 
ginning of another period, called the period of erup- 
tion. Divided into groups and fixed in the skin or the 



472 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

mucous membrane, they remain there for some time, 
exciting a suppurative inflammation which constitutes 
pustulation ; this is only an effort on the part of the 
organism to eliminate the living or dead bodies of the 
parasites, and restore the tissues in which they have 
developed to their primitive condition of integrity and 
health. With regard to the sulphide of calcium, it 
participates in the antiparasitic properties of all the 
derivatives of sulphur, which are decomposed either 
provisionally or finally, and liberate hydrogen sul- 
phide. The sulphide of calcium is constantly liberat- 
ing hydrogen sulphide, and the promptness and cer- 
tainty with which its ingestion is followed by eructa- 
tions and the characteristic odor of the gas are sufficient 
proof that the decomposition in question is going on. 
Sulphide of hydrogen instantly destroys the lower forms 
of animal life, and if it were inhaled in sufficient vol- 
ume it would also destroy the higher forms of animal 
life as well. Its application in the treatment of variola 
may therefore be understood, and if we add that this 
gas, on account of its diffusibility, can penetrate every 
tissue and cell of the body, and in particular can pene- 
trate the surface and be eliminated with the virus of 
the disease, better than any other product of sulphur, 
we shall have given the reasons in brief for giving this 
agent the preference. The indication, furnished by a 
knowledge of the nature of variola, being to kill all the 
parasites as soon as they begin to multiply, that is, as 
soon as the fever appears, and the sulphide of calcium 
being an agent which can destroy them, it would ap- 
pear that the conclusion might be drawn that the appli- 
cation of this medicament to this disease is a rational 
procedure. Is this treatment efficacious % Do the facts 
show that sulphide of calcium in small doses will miti- 
gate the disease, and in large doses will destroy it? 
Do they show that if it is not given before the germs 
multiply it has little influence upon the disease, and 
that if it is interfered with too soon it (the disease) will 



ELEMENTS OF DOSIMETRIC PRACTICE. 473 

reappear % Experience, repeated in different places and 
on different occasions, enables the author to answer 
these questions in the affirmative. After what has been 
said in regard to the nature of the determining cause 
of variola and the properties of sulphide of calcium, 
certain rules will follow to which the treatment must 
be conformed in order to be really efficacious. These 
rules, which might appear to be of secondary impor- 
tance, are on the contrary quite essential, and, with- 
out careful observance of them, the results would not 
only be doubtful, but they might not be produced at all. 

1. The treatment must he begun wlien the nature of 
the disease is suspected. During an epidemic, chills 
followed by fever, and acute pain in the head, though 
there may be no symptom indicating a localization of 
the disease, will furnish sufficient motive for institut- 
ing treatment, and, if this is begun in time, the febrile 
symptoms of the invasion will almost always be dissi- 
pated, and the eruption be prevented. If it is remem- 
bered that the parasites announce their multiplication 
by the symptoms mentioned, and that the more numer- 
ous they are the sooner they will work their way to the 
skin, it will be evident that the opportunity of destroy- 
ing them at the beginning should not be lost, and that 
our action should be the more energetic as the period 
for the eruption approaches. To allow the disease to 
be established is to lose the best, not to say the only, 
means for overcoming it easily. 

2. The treatment should be so conducted as to sat- 
urate the organism with the parasiticide. It is evi- 
dent that the microbes which produce the disease are 
distributed in all the tissues and involve all the or- 
gans, and, consequently, that it is necessary to give the 
sulphide in sufficient quantity to impregnate the entire 
organism. 

3. The organism must continue in this condi- 
tion of saturation until it is certain that the de- 
sired effect has been obtained. If this were not done 



474 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

the microbes which remained would profit by the 
armistice which was extended to them, and continue 
their disastrous invasion, which our imprudence would 
have made successful, and which would neutralize all 
the preceding efforts. Besides, as the sulphide of cal- 
cium, or the hydrogen sulphide which it liberates, is 
rapidly eliminated by the skin or by the lungs, if we 
cease the administration of the remedy, the organism 
will in a minute be completely at the mercy of the 
enemies which are attacking it. 

4. Even after the eruption has commenced it can 
be made td retrograde as long as there is no effusion 
of liquid in the swellings. The result in such cases 
can not be accurately predicted, at least with regard to 
the complete disappearance of the eruption. Rigorous 
treatment may be very useful, however, possibly by 
transforming a confluent into a discrete eruption, and 
attenuating the disease so that it may be reduced even 
to a varicella of greater or less severity. The general 
symptoms promptly disappear, the secondary fever is 
avoided, and the patient is enabled to bear his disease 
with as little discomfort as he would a simple eruption. 
Contrary to that which happens in cases of variola 
which are untreated, or are treated by the ordinary 
means, the disease gets better every day, and on the 
eighth day of the eruption, instead of seeing the pa- 
tients in a disgusting condition, we find them happy 
and satisfied, and hopeful of soon leaving the bed 
which has not been for them a bed of torture. 

5. After pustulation the use of sulphide of calcium 
will still enable us to ward off complications, to de- 
stroy the offensive odor, to reduce the fever, and to 
attenuate the severity of the disease by hastening the 
process of desiccation ; but its influence upon the dura- 
tion of the disease is not so decided as it is in those 
cases in which it is taken earlier. 

6. Sulphide of calcium being a substance icliicli 
has a disagreeable odor, and being required in small 



ELEMENTS OF DOSIMETRIC PRACTICE. ±75 

doses frequently repeated, no preparation of it seems 
to be more suitable than the dosimetric granules. The 
granules contain one centigramme each of the sub- 
stance ; patients can take them without trouble, and 
their great solubility enables one to take them at very 
short intervals. 

7. The character of the treatment must be regu- 
lated by the effect which it is designed to accomplish. 
If the patient is still passing through the period of 
invasion, no eruption having appeared, or the erup- 
tion being still slight, no time must be lost, and the 
patient must at once receive one or two granules of the 
remedy, the dose being repeated every quarter-hour . If 
the patches of eruption have already appeared, we will 
be compelled either to seek to retard the disease or to 
limit ourselves to its attenuation. In the first case we 
should still give the sulphide of calcium every quarter- 
hour, re-enforcing its action if necessary by means of 
salicylic acid. In the second case we should give the 
granules every half-hour or hour, according to the 
diffusion of the eruption and the degree of attenuation 
which is desired. It will be observed that no indica- 
tion has been given as to the limit of the dosage — one 
or two granules should be given each time ; and this 
plan should be continued until the desired effect has 
been obtained. It must be understood, however, that 
the maximum of saturation is indicated by the vomit- 
ing of biliary matter, preceded by a feeling of oppres- 
sion in the stomach. When these symptoms are present 
it is not necessary to stop the treatment altogether, for 
this would be equivalent to rendering all the advantage 
previously gained of no avail ; instead of this, the 
granules should be given at intervals of half an hour, 
which will generally suffice to remove all the symptoms 
of intolerance. After a few hours the doses can again 
be given at intervals of a quarter of an hour, the object 
being to keep the organism in a condition of saturation 
with the drug, without which complete success will 



476 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

always be a matter of doubt. An evidence of the ac- 
tion of the drug which is frequently seen is profuse 
perspiration, especially at night. The patient may 
take soup, milk, or water while he is undergoing medi- 
cation with the sulphide of calcium, without any dis- 
advantage ; the only danger is that which will come 
from an interruption of the treatment. Should the 
fever reach 39 -15° C. to 40° C, and perspiration be de- 
layed, a granule of aconitine should be given with the 
calcium every half-hour, and this, by moderating the 
fever, will facilitate diaphoresis, and soothe the patient. 
After the disappearance of the fever and the other 
symptoms, and when we are sure that the organism 
has come out of the struggle victoriously, we must give 
Sedlitz Chanteaud to relieve the intestines of the resi- 
due of the septic material which has resulted from the 
fever, and to eliminate from the system the mater ies 
peccans, in the shape of the remains of the infecting 
parasites, by which means the patient will be delivered 
from many dangers and spared many sufferings. Chil- 
dren should be treated in the same general way as adults, 
that is, the remedy must be continued until the result 
' is obtained. Usually the evidences of saturation will 
be apparent with them much sooner than with adults, 
but we must not be frightened by that. The author 
has given sixty to one hundred and forty granules of 
the sulphide daily, in doses of one or two granules, 
without cause for regret, and without particular in- 
convenience to the patients. An erroneous idea, 
sustained by tradition but not by facts, may give 
rise to the fear that this treatment would, sooner or 
later, prove harmful to those who use it. Usually 
it is such opinions, which have no substantial foun- 
dation, which escape logical discussion and the con- 
trol of facts. As the marine algce, suspended in the 
water, yield readily to the impulse of the waves and 
the force of the currents, but never abandon their first 
position, so is it preconceived ideas and errors which 



ELEMENTS OF DOSIMETRIC PRACTICE. 477 

do not defend themselves before reason and experience, 
and still are none the less active and respected as 
authorities of great value. The spirit of modern times 
repudiates a bare hypothesis, and considers only ob- 
servation and reason. Observation and reason are on 
our side, and enough has been said to remove all doubt 
in this respect. Nevertheless, let us seek to remove all 
scruples, and to those who object that a variola, the 
development of which is prevented, may be a source of 
injury, it may be said in reply : (1) That in the 
period of invasion, since no variola has been formed, no 
variola can have entered the organism. (2) That in 
the period of eruption, since there are not yet any prod- 
ucts of exudation in the skin, but only a collection of 
small localized hypersemias, the striking back of the 
vesicles is neither to be feared nor even possible, for 
the vesicles do not yet exist. The danger is not greater 
than in a case of spontaneous cure of an urticaria. 

(3) That in the periods of vesiculation and pustulation, 
the resorption of the contents of the pustules is a 
matter of great danger ; but that just in these periods 
we are unable to repress the disease. If this point is 
reached the disease must run its course ; and, if our 
action at this time is of no value, it is also not harmful. 

(4) That the disappearance of the maculse, the vesicles, 
or the pustules being a gradual process, and provoked 
by internal treatment followed by profuse sweating, does 
not at all resemble that which occurs when the vesicles 
appear suddenly and in obedience to external influences. 

(5) That the demonstration of facts in a matter of 
this kind being the most trustworthy evidence, those 
who are skeptical as to the value of this treatment are 
invited by the author to visit with him his patients who 
have been enabled to avoid the exudative period of the 
disease. For all the foregoing reasons the sulphide of 
calcium in sufficient doses is recommended as the 
dominant of the treatment from the beginning to the 
end of the disease, and it is advised in addition that 



478 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

it be also given as a preventive during an epidemic. 
While it could not be guaranteed that it will prove an 
effective means of prevention, it may be said that no 
inconvenience can attend the use of six to twelve gran- 
ules daily, and it must be influential in preventing the 
development of the microbes of this disease. It does 
not always suffice to control the disease rapidly and 
efficiently in all its periods. The different character- 
istics which the disease shows in different epidemics, 
owing to the particular conditions appertaining to the 
morbific agent, the condition of medium and of indi- 
vidual, as well as the natural phases in the evolution of 
the disease, should enable us to decide upon the proper 
agents for the variant of the treatment. Should the 
malignant character of the epidemic or the excessive 
development of the bacteria be such that the sulphide 
of calcium is insufficient, it should be combined with 
salicylic acid or the salicylates, which have bactericidal 
properties which are unquestionable. The different 
phases of the disease, which must not be confused with 
the periods which have been established by the pathol- 
ogists, also have particular indications. In the phase 
of invasion, when there is scarcely any fever or any 
congestive phenomena, one granule each of the defer- 
vescents — aconitine, veratrine, and digitaline — should 
be given every hour to facilitate the appearance of the 
eruption and to soothe the pain, which is so trouble- 
some at this time. The vomiting which sometimes oc- 
curs during the first days of the fever may interfere 
with the treatment. In such a case we should give one 
granule of strychnine and one of hyoscyamine every 
half-hour, which will render defervescent treatment 
possible by soothing the irritability of the stomach. 
Troubles in the nervous system, pain, delirium, con- 
vulsions, and dyspnoea will also yield to defervescent 
agents. Pain in the back may be relieved by one gran- 
ule of tannate of cannabine every half-hour. When 
the eruption begins to appear the defervescent treat- 



ELEMENTS OF DOSIMETRIC PRACTICE. 479 

menfc must be suspended, the sulphide of calcium and 
the salicylate of quinine being continued, in order to 
profit by the remission of fever which accompanies this 
period. In those cases of variola which are treated 
dosimetrically from the beginning, one never sees symp- 
toms of a particularly grave character at this period. 
On the other hand, both cerebral and thoracic troubles 
may appear at this time if patients have been treated 
by the expectant method, and, as in all cases in which 
there is visceral congestion, we should treat these 
troubles with strychnine and aconitine. The phase of 
suppuration is certainly the one which is the most 
perilous for the patient. Would not this be a condi- 
tion in which Paquet's method of overcoming acute 
suppuration could be applied ? Would it not be proper 
to administer the arseniate of quinine and iodoform 
from the beginning of the suppurative process ? It is 
for clinical experience to answer these questions. As 
yet the facts are too few to give an absolute reply. 
The sulphide of calcium must not be suspended, but 
may be given in smaller doses combined with the sa- 
licylate of quinine or of iron, strychnine being added 
to combat the adynamia which frequently occurs, and 
with serious result, at the time when the eruption ap- 
pears. If the fever is very high it may be moderated 
with aconitine and the arseniate of quinine, but without 
any attempt to remove it altogether. With regard to 
absorption, it is better to prevent any occasion for it. 
Asphyxia of the skin, which results from the conflu- 
ence of the pustules, is, of course, irremediable. Dur- 
ing the period of desiccation the digestive functions 
should be made as active as possible by means of 
strychnine and quassine, convalescence being thus en- 
couraged. Other agents may also be used for the vari- 
ant in addition to those which are here mentioned ; 
these are only the principal ones. It will rarely be 
necessary to formulate a complex treatment. Grave 
and abnormal cases will become less and less frequent, 



480 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

for therapeutic intervention is always most efficacious 
at the beginning of diseases, not only because the con- 
ditions which then obtain will then yield most readily, 
but also because many complications can then, be pre- 
vented, and in that way the gravity of the later phases 
of the disease can be prevented. Before the days of 
dosimetry the physician, like the hunter, was forced to 
wait patiently until the game passed his door and en- 
abled him to see it ; then the precipitation of the favor- 
able moment, the consciousness of danger, and the force 
of the resistance which was offered, were likely to affect 
the certainty of his aim, and sometimes made him the 
victim. Nowadays success is more sure, for, in addi- 
tion to new weapons of precision, we have the means of 
attacking the beast in his lair and killing him while he 
is asleep, all the doors of escape having been closed. 
In most cases it will be sufficient to use the sulphide of 
calcium with the defervescents during the invasion, and 
the sulphide of calcium with strychnine or quinine dur- 
ing the eruption. The duration of the disease, in spite 
of the pathologists who obstinately consider it as fixed 
with mathematical certainty, as if there were no such 
thing as therapeutics, will be much abridged by follow- 
ing this plan of treatment. The patient will suffer less, 
and the family and the physician will be delivered from 
the fears to which they have heretofore been subjected 
by a disease in which, according to Jaccoud, death is 
the rule and recovery the exception. Only the absolute 
want of efficient means can excuse the physicians of the 
regular school for their treatment of this disease by the 
expectant method. In order to have a just opinion of 
its gravity, we have only to find out whether it is con- 
fluent or discrete, and let this be the measure of its 
mortality. But, though we may admit that we have 
nothing to fear as to the result in a given case, is there 
no duty that we should seek to arrest its course % Has 
the physician no duty to perform in seeking to restore 
his patient to his family and society and the activities 



ELEMENTS OF DOSIMETRIC PEACTIOE. 



481 



of life as soon as possible ? There can no longer be any 
excuse as to the want of means for treating this disease, 
for dosimetry offers as good as can be desired. Con- 
venient and agreeable, sure and effective, pure and well 
prepared, what further qualities can be desired? Do 
they say that these agents are alkaloids — poisons? 
That is true for some of them but not for others, and, 
besides, if they are used in accordance with the rules 
formulated by Burggraeve, they will always prove to 
be remedies and never poisons. It is not sufficient to 
merely administer the granules, one must know how to 
administer them — in other words, one must be a do- 
simetrist. If the allopaths wish their patients to enjoy 
the benefits of this therapeutic reform they must aban- 
don the uncertain, obscure, irrational, and superstitious 
methods which they have followed in the past, and de- 
vote themselves to the study and the practice of dosim- 
etry. When more than two thousand physicians ex- 
press their satisfaction with dosimetry, it is a duty to 
try it, for how many methods of treatment in allopathy 
are there with which two thousand physicians will ex- 
press satisfaction ? It is necessary, therefore, to give it 
a trial, but to try it in a proper manner — that is, as the 
results of experience obtained from physiological in- 
vestigation should be applied — not as one is in the habit 
of making therapeutic experiments ; in other w r ords, it 
should be tried in accordance with the rules which were 
taught and faithfully practiced by the immortal Claude 
Bernard. 






Dominant. 



Variant. 



Parasitic infection 

( Fever 

Vomiting . 

Delirium . 
Convulsions 
Dyspnoea . 
Rhachialgia 
Visceral congestion 
Suppuration 

Adynamia 

^ Gastric atony . 



j Sulphide of calcium. 

\ Salicylic acid, salicylates. 

Aconitine, digitaline, veratrine. 
( Sulphate of strychnine, hyoscya- 
\ mine. 

y Defervescents. 

Tannate of cannabine. 
Aconitine, sulphate of strychnine. 
Iodoform, arseniate of quinine. 
Arseniate of strychnine, generous 

wine. 
Quassine, pepsin. 



31 



482 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

Vesania. — See Mental Alienation. 

Vulvitis, — Inflammation of the mncons membrane 
included between the labia major a and minora may- 
be simple or scrofulous in character ; phlegmonous, in 
which case it terminates by suppuration ; or gangren- 
ous, if a portion of the mucous membrane becomes 
mortified, which is usually seen only after parturition. 
Syphilis and blennorrhagia may also produce vulvitis, 
the local lesions being received upon the vulva, or being 
the result of extension from another portion of the 
genital tract. Their specific treatment has been re- 
ferred to in connection with other subjects. Simple 
vulvitis, which is usually caused by repeated irrita- 
tions, or by traumatisms of one kind or another, has 
for its dominant aconitine ; one granule should be given 
every two hours. The local pain may be relieved by 
the use of simple emollient topical applications, such 
as glycerin or vaseline, or sedatives, such as hydro- 
chlorate of morphine, in a two-per-cent ointment or 
solution. Phlegmonous vulvitis must be treated by 
surgical means, by disinfectant applications (e. g., cam- 
phorated vaseline), and internally by two granules of 
iodoform and two of arseniate of quinine every three 
hours. The same treatment is equally applicable to 
furuncular vulvitis. Should the inflammation termi- 
nate in gangrene, irrigations of camphorated alcohol 
should be made, and applications of iodoform in pow- 
der during the intervals. Internally two granules of 
salicylate of ammonia should be given every hour to 
counteract septicaemia. The action of the latter may 
be aided by the other salicylates, especially the salicy- 
late of quinine, three granules being given at each dose. 
Scrofulous vulvitis should be treated with such topical 
absorbents and astringents as subnitrate of bismuth, 
oxide of zinc, and glycerole of tannin, and the internal 
use of arseniate of soda and iodoform. Should the 
pruritus be intolerable, two granules of hydrobromate 
of cicutine may be given every hour. Should hyper- 



ELEMENTS OF DOSIMETRIC PRACTICE. 483 

secretion from the mucous membrane persist after the 
other principal symptoms have been relieved, powdered 
tannic acid may be used locally, and also internally 
in two-granule doses four times daily. Adenitis, which 
often accompanies simple vulvitis, and is a simple 
glandular inflammation which has been excited by 
transmission through the lymphatic circulation, should 
be treated with one granule of aconitine and one of 
iodoform every two hours. 

f Simple vulvitis . . Aconitine. 
ai / r» , J Phlegmonous vulvitis . Iodoform, arseniate of quinine. 
hh Uominant. i Gan g renous vulvitis . Salicylates. 

jrj J [ Scrofulous vulvitis . Iodoform, arseniate of soda. 

2 \ [ Pruritus . . . Hydrobromate of cicutine. 

^ v tt J Hypersecretion of mu- j Tannic acid, topical use of 

> \ VARIANT - 1 cus . ( astringents. 

[Adenitis . . . Aconitine, iodoform. 

Whooping-cough. — Whooping-cough is one of the 
numerous diseases which demonstrate the fluctuations 
of scientific opinions and the uncertainty of therapeu- 
tic means. For some, whooping-cough means simply 
an inflammation of the interglottic ventricle ; for others, 
it means a spasm of the glottis, which may be simple 
or complicated with laryngitis. The latter attribute it 
to a hypertrophy of the tracheo-bronchial glands ; the 
former to the influence of a particular parasite. The 
latter is the opinion which should be accepted, because 
it is the only one which explains the principal acci- 
dents of the disease. Burggraeve states that whoop- 
ing-cough should be classified with diphtheria, and 
attributes it to the presence of a penicillium in the 
respiratory passages. Letzerich has been able to dis- 
cover and cultivate a micrococcus which appears to be 
the true cause of the disease. The contagious charac- 
ter of the disease, its symptomatology, which is so 
different from that which is observed in connection 
with other lesions of the respiratory apparatus, the 
regular succession of its periods of incubation, devel- 
opment, and disappearance, and the efficacy of anti- 
parasitic means of treatment, fully confirm the parasitic 



484 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

theory of the disease, and enable one to reject all 
others. The dominant of the treatment will, therefore, 
be satisfied with the sulphide of calcium, taken regu- 
larly and in large doses, in order to keep the organism 
for some time constantly in an internal atmosphere, as 
it were, of hydrogen sulphide. Two to five granules 
of this drug should be given every two hours or of tener, 
the quantity being regulated by the age, facility in 
taking it, and tolerance of the patient. Its administra- 
tion should be commenced when the first spasmodic 
attack occurs, or even during the catarrhal period if 
circumstances indicate the probable development of 
spasmodic catarrh. At the beginning of the disease 
we may hope to abort it by active and regular treat- 
ment. Harmful effects from the sulphide of calcium 
need not be apprehended, for there are none. There 
may be nausea produced by the bad odor of the eructa- 
tions, but that is all. Children can take the granules 
easily, either triturated with a little sugar or a little 
milk, or entire, if the children are not too small, and 
if they are accustomed to dosimetric treatment. To 
habituate children to taking remedies readily should 
form a part of their early education ; when they are 
in good health one should occasionally give them a few 
inert granules or globules, and teach them to swallow 
them without chewing them. In this way much time and 
trouble might be spared when they are sick. This ad- 
vice, which all physicians ought to give to the mothers 
in their clientele, may seem trifling, but its importance 
will be thoroughly recognized when one is called to treat 
a severely sick child, and medication is required which 
will promptly control it. If the child has previously 
been taught to swallow the inert granules, he will now 
have no trouble in swallowing the active ones ; on the 
contrary, one who has not been so taught will take the 
medicine with difficulty or not at all, and instead of 
improving may get worse and die, with the medicine 
which has been left for him within reach. The treat- 



ELEMENTS OF DOSIMETRIC PRACTICE. 485 

ment of this disease should be governed, in some re- 
spects, by the period in which it is used. In the ca- 
tarrhal period we either know the nature of the disease 
or we do not know it. If we know that it is whooping- 
cough we should give sulphide of calcium, and, if the 
catarrhal symptoms are aggravated, a granule of hele- 
nine, which is an important agent in the cure of this dis- 
ease, should be added every two hours. If the diag- 
nosis is doubtful, we should treat the case, especially 
in the time of an epidemic, as if there were no doubt 
that it was whooping-cough. Not only is such treat- 
ment useful at the beginning of this disease, but it also 
is decidedly efficacious in all cases of simple catarrh. 
In the spasmodic period there is an affection of the 
upper portion of the larynx in addition to the funda- 
mental cause. The simple presence of the micrococci 
or their secretions produces such an irritability at the 
peripheral ends of the nerves that the slightest provo- 
cation will excite a paroxysm. Crying, motion, a deep 
breath, in a word, anything which displaces the mucous 
secretion, or anything that increases the nervous excit- 
ability, will suffice to bring on a new attack. This ex- 
citability is frequently communicated to the stomach, 
and vomiting occurs not infrequently with each attack 
of coughing. This exaggerated condition of contractil- 
ity should be treated with half a granule or a granule 
of hyoscyamine or valerianate of atropine three times 
daily. Should the vomiting be so persistent that the 
patient suffers for want of alimentation, one or two 
granules of morphine or codeine must be given before 
each meal. These remedies must be given until the 
patient is relieved, unless they are contra-indicated by 
the patient's age or the cephalic congestion which is 
induced by the paroxysm. Two granules of the bro- 
mide of camphor may also be used with advantage 
every two hours, its action being analogous to that of 
helenine. An intermittent character of the paroxysms 
is in some cases an indication for the use of two gran- 



486 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

ules of the hydroferrocyanate of quinine three times 
daily, especially when they seem to be provoked by 
hyperesthesia of the larynx rather than an accumula- 
tion of mucus. If expectoration is abundant two gran- 
ules of helenine should be given four times daily, and if 
it is very viscid in character, the helenine should be 
combined with scillitine. In some cases the heart be- 
comes very irritable or ataxic, owing to the fatigue 
resulting from the repeated attacks. To soothe and 
strengthen the heart, two granules of digitaline and 
two of aconitine should be given every evening. To 
very young children, one granule of each will be suffi- 
cient once or twice daily. If haemorrhages are easily 
excited in certain organs in connection with the parox- 
ysms, three granules of ergotine should be given three 
times daily. Loss of appetite is always a grave com- 
plication and must never be neglected. Two granules 
of quassine should be given three or four times daily, 
before eating. Nocturnal attacks, on account of the 
fear which they excite in some children, are a cause of 
insomnia, and this greatly aggravates the want of equi- 
librium in the nervous system, which is already seri- 
ously compromised by other morbid conditions. The 
child may be soothed by giving him at bed- time two 
or three granules of the hydrobromate of morphine, 
three to five granules of narceine or codeine, or five to 
eight of the bromide of camphor. Either of these 
agents may be replaced by three to five granules of cro- 
ton chloral every evening, if for any reason it is desir- 
able to make a change. As the disease passes away, 
that is, in its last stage, the pneumogastric nerve ap- 
pears to be habituated to the contact of the parasites, 
and consequently does not react with the same violence 
nor with the same tenacity when irritated. This is the 
time when we must aid the system to repair the loss 
and damage which have occurred to it in this long strug- 
gle. To tone up the respiratory apparatus we should 
give two granules of apomorphine three or four times 



ELEMENTS OF DOSIMETRIC PRACTICE. 487 

daily. Two granules of the benzoate of soda and two 
of the benzoate of ammonium may also be used for the 
same purpose four times daily. For general debility, 
if the child be very young, we should give one granule 
of the hypophosjjhite of strychnine or of brucine three 
times daily. To overcome the ansemia two granules of 
the hypophosphites of soda and of lime should be 
given at each meal, and equal quantities of the phos- 
phate of iron. The most frequent complications are 
bronchitis and broncho-pneumonia, both of which are 
of exceedingly grave import. The ordinary treatment 
of these inflammations should be modified by bringing 
the tonics brucine and apomorphine into the list of 
therapeutic agents. The treatment which is recom- 
mended for this disease can therefore be summarized in 
a few words. For dominant, the sulphide of calcium 
combined with helenine for the catarrhal element, and 
bromide of camphor for the spasmodic. For variant, 
those agents should be used which, while increasing 
synergically the efficiency of the dominant, will find 
their particular application in the modification of the 
symptoms. It must also be remembered that this dis- 
ease is often exceedingly rebellious, now because it was 
not suitably attacked at its beginning, and again be- 
cause sufficient care has not been taken in observing 
the precautions which are indispensable, for it is very 
important that the patients should have an abundance 
of pure air, and, at the same time, that they should not 
take cold. Parents and friends, seeing no change in 
the patient's condition after several days of treatment, 
are impatient to have it changed, though they may be 
perfectly well aware that the disease is always of long 
duration. The physician must satisfy the impatience of 
the family by modifying the variant, but he must not 
interfere with the dominant. The final result will always 
be in favor of dosimetric treatment. The classical method 
of treating whooping-cough is a chaos. Owing to cul- 
pable condescensions and the requirements of different 



488 ELEMENTS OF THERAPEUTICS AND PRACTICE. 

families, it no longer has any remedy in which it con- 
fides. It stops the use of a drug before it has produced 
its effects. How can any conclusion be drawn from 
such practice % The agents which are most approved 
are hydrocyanic acid and emetics. The first, advised 
by West, is uncertain and dangerous ; the others, 
while they may sometimes be useful and soothing to 
the patients, are in the end harmful, because they 
weaken and depress the activity of the pneumogastric. 
Only in exceptional cases, when asphyxia is extreme 
and suffocation imminent because the patient can not 
expel the mucus, are emetics indicated. In such cases 
three granules of emetine dissolved in a little warm 
water should be given every ten minutes until the de- 
sired relief is obtained. Emetic medication has well- 
defined indications, but it should never be regarded as 
curative treatment. 



WHOOPING-COUGH. 



Dominant. 



period 



Variant. ( 



Spasmodic 
period . 



Parasitic element 
/Catarrhal j Catarrhal element 
\ Spasmodic element 
/ Spasm of the glot- 
tis 
Irritability of the 

larynx 
Intermittence in 

the attacks 
Viscid expectora 

tion . 
Inability to expec 

torate 
Cardiac ataxia 
Haemorrhage 

Insomnia 

Want of appetite 
v Vomiting 
/ Atony of the vagus 
Catarrhal hyperse 
Period of cretion 

disappear- General debilitv 
ance • 

Anaemia 



Sulphide of calcium. 

Helenine. 

Bromide of camphor. 
) Hyoscyamine, valerianate 
\ of atropine. 

j- Bromide of camphor. 

[ Hydroferrocyanate or hy- 
) drobromate of quinine. 

y Scillitine. 

y Emetine. 

Digitaline. 

Ergotine. 
j Narceine, codeine, croton 
( chloral. 

Quassine. 

Morphine. 

Apomorphine. 

y Benzoate of ammonia. 

Brucine, hypophosphite of 

strychnine. 
Phosphate of iron. 
Hypophosphites of lime 

and of soda. 



THE END. 



DOSIMETRIC LIBRARY. 



In order to establish the dosimetric system of medicine, it was 

first necessary to arrange its materia medica, and then to promulgate 

the method of using it. The first duty was assigned to my collaborator, 

Charles Chanteaud, and it is well known with what conscientious 

fidelity he has fulfilled his task. All physicians who have used his 

preparations will bear testimony as to their efficiency. Attention to 

the published works devolved upon me, and it can not be said that 

I have lost much time. It has been my task to create an entire 

dosimetric library. 

Db. BURGGRAEVE. 



WORKS OF PROFESSOR BURGGRAEVE. 
1. — Publications be luxe. 
Monument to Jcnner, a magnificent quarto volume, "with a portrait of Jenner. 
The genius of contemporary surgery, third edition, 8vo, with portrait of Vesalius. 
History of anatomy, 8vo, with cuts. 

Course in surgery, theoretical and practical, with plates. 8vo. 
Studies on Hippocrates, with portrait. 8vo. 
Indian cholera, with plates. 8vo. 
Medico-ceconomic studies. 
The golden book of dosimetric medicine. 

2. — Manuals for the use of physicians. 
Manual of dosimetric therapeutics, or exposition of the system and different 

conditions for which it is applicable. One volume. 
Manual of dosimetric pharmacodynamics, or mode of action of dosimetric 

medicaments. 
Manual on dyspepsia, and its treatment by the dosimetric method. 
Manual on fever, and its treatment by dosimetry. 

Manual on diseases of women, and their treatment by the dosimetric system. 
Manual on the diseases of children, and their treatment by dosimetry. 
Compendium of dosimetric medicine ; or medical, chemical, pharmaceutical, 

pharmacodynamical, and clinical studies, by Dr. Albert Van Renterghem, 

Goes (Zealand). 
A new practical guide to dosimetric medicine. (This is simply a very clear and 

concise exposition of the doctrine of dosimetry.) 
In press : Organon of dosimetric medicine. Second part, symptomatology. 

(The foregoing are merely translated titles of the original French works, 
which, so far as the translator is aware, have not as yet been rendered into 
English.) 
Universal repertory of dosimetric medicine. (Human and veterinary medicine 

comparatively considered.) A monthly journal. 



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